Role of clinical examination in patient care


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Role of clinical examination in patient care

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Role of clinical examination in patient care

  1. 1. ROLE OF CLINICALEXAMINATION IN PATIENT CARE Dr.T.V.Rao MD I was a Medical student in 1969, posted for learning bed side medicine in a Government Hospital Belgaum, Karnataka , Our teachers were knowledged, and committed to the punctuality, we were all expected to be presentourselves in Time with bright faces to create some hope in the patients at the first instance, Making us to realise HOPE is the best word in Medicine and rest all secondary as we had few drugs to treat the patients and rarely investigated , however on many occasions patients were awaiting for our presence, Our chief’s used to introduce that we are future Doctors so save many in the world, and He or She should cooperate with them, it was great boost for all of us, no patient refused to accept us as Junior Doctors, they used to tell their personal problem and later we used to convey to our chiefs the hidden History of the patients ailments. I always felt Medicine is a Clinical skill and not in book or great volumes in Library. My most memorable teacher was Late S.J. Nagalotimath the Pathology Professor he used to take us to Pathology museum and teach us so many facts beyond pathology, He used to take a specimen mounted with Cancer lung, and tell us, there is nothing in this lung expect morbid facts, the problem is with pollution, and smoking. Today how many teachers we find, like him in the country to remember. Nowit is rare to find Professors getting up from their chair, and wish only to command respect for the position and not for contributions. I am proud to be student of J.N Medical College, Belgaum, our Museums in Anatomy and Pathology are marvels in teaching than morbid knowledge, everything was actively clinical dissemination of Knowledge and they live after the doyens who have done it. Today after 4 decades, being in Profession in abroad and India the poor quality of Doctors in India is due lack of skills and poor clinical knowledge , In beginning just knowing little Clinical observation has been a part of medicine since Egyptian, Babylonian, Chinese and Indian physicians began examining the body thousands of years ago. Clinical reasoning and bedside diagnosis first played a role in ancient Greece when Hippocrates began measuring body temperature, evaluating the patient’s pulse and palpating the abdomen. But it wasn’t until the 19th century that physical diagnosis exploded, with such developments as percussion and auscultation—the tapping and listening those physicians still practice. Sir William Osler, M.D., often described as the father of modern medicine, told his students: “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” Medical college faculty continue to dole out such advice to their students today. We cannot underestimate the power of technological advances in the modern times as “We have technology that allows us to see things we could never see before, hear things we could never hear before. So in a sense technology has expanded our ability to replace a certain sector of the examination with either visual data or other kinds of data that weren’t available to us. Today many patients think that we are Technicians ordering test without examining them or even talking to them, Osler was a pioneer in this area, advocating clinical demonstrations in the third year of medical school and clinical clerkships in the fourth. The current model came into use in the 1950s, with schools moving the clerkships to the third year and the fourth year devoted to hospital rotations. But because these experiences varied so much from institution to institution, clinical education came under closer scrutiny. Between the 1980s and the early 1990s, five major reports focusing on the quality of medical education were issued—see today many Physicians are already with diagnostic requisition from before the patient tells few words. The problem with technology arises when doctors rush to order tests without first performing a thorough physical
  2. 2. exam. Doctors may be overly reliant on tests because they have confidence in the results; however, tests aren’t always accurate. Lyme disease, or Typhoid common cold, for example, often hasthe differentclassic signs of rash, fever and muscle aches, pattern of temperature yet the blood tests are often negative.Many sensible Doctors added, allows for optimal use of the physical exam and more selective use of technology. Think before you write elaborate diagnostic tests, Studies have consistently shown that the patient’s history and physical examination are the most important factors in arriving at a correct diagnosis, whereas lab tests and imaging studies play complementary roles, and that excessive reliance on technology hasn’t necessarily improved the quality of patient care. Many think “We have to work hard to reinforce both the approach to patient care and the specific physical exam skills that are taught in the preclinical years to show students their usefulness and effectiveness at the bedside. But it’s hard to deny the importance of learning those skills and having an opportunity to practice them again and again if they are to remain useful. “Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control,” Osler told his students. Just remember one thing. Whether the patient is a patient in real life, or a patient in an exam, they are a human being. A person. At some point, they'll be you. I learnt many things as a Microbiologist that everything in Medicine is clinical and Human it is not urine, blood or excreta, just realise there is some lesson behind everything we analyse, "Always listen to the patient, they might be telling you the diagnosis. William Osler. The best words I listened in my life from Dr Bhat a Renowned urologist spoke at SVIMS Tirupati on his life time achievement, Just Doctor realise you may be on other side of the Table, Throughout his career, he was a defender of patients' rights and prerogatives. The very work culture of his department was a potent validation of such rights; no surgery was ever performed without a succinct and decipherable explanation of the planned procedure to the patient. And, he insisted that we pay attention to drafting exquisite discharge summaries loaded with strategic details. The summaries were always scrutinised and amended further by Dr. Bhat, who removed verbiage, and added greater reasoning. Another great Teacher and an Urologist I am associated with Dr. K. Sasidharan, our Dean at SVIMS Tirupati, AP he used to tell me any one can become a famous in any speciality ifone have respect for the Human being and the tissues you operate. I wish to express to my students, Listen to the patient, practice a human touch and try to solve the problem, above all in all our actions God is with us? Dr.T.V.Rao MD Professor of Microbiology, Freelance writer.