My Dad died yesterday. First time I've cried in seven years.
Hard as nails, heavy as lead.
Rest now Richard the Lionheart.
In the end, Nature was merciful.
There is a lot more there, but it's mine.
Tuesday, November 24, 2009
Saturday, November 7, 2009
Data point
In preparation for the job - going out and dealing with actual people - part of medical training involves interviews with simulated patients. One of these turned up recently with the presenting complaint of tiredness, and you had five minutes or so to write down anything you felt pertinent before going in and doing the interview.
Me being me approached it thusly - a relatively difficult stem (at this stage in training) would be accompanied with an easy diagnosis (A modus operandi D&D players will know as metagaming. Not realistic, but these exams are flawed in more ways than one anyway). So I wrote down 3 differentials - hypothyroid, anaemia and diabetes, a few probing questions for each and upon entering had enough evidence to call the correct diagnosis in about 30 seconds.
In, out, answer, win. But not really. It's a character flaw of mine that means I often think very haphazardly, racing through to the end to finish more quickly at the expense of thoroughness. 9/10 times it makes no difference.
Still isn't good enough though. Neither would 99/100 or 999/1000.
It is going to take quite a shift in direction to relearn not so much a greater attention to detail (though that is important), but more different method of approaching the same situation.
What I should have done is taken the presenting complaint - tiredness - and worked from the ground up. Pathology in what systems can produce tiredness - CVS, Resp, GIT, Haemopoietic, Endocrine, Psychological (depression), etc; take a systems review of those.
As a very wise person once told me: The diagnosis is the end, not the beginning. Do the process right, and the diagnosis will fall out.
Start at the start. I have some unlearning to do.
Me being me approached it thusly - a relatively difficult stem (at this stage in training) would be accompanied with an easy diagnosis (A modus operandi D&D players will know as metagaming. Not realistic, but these exams are flawed in more ways than one anyway). So I wrote down 3 differentials - hypothyroid, anaemia and diabetes, a few probing questions for each and upon entering had enough evidence to call the correct diagnosis in about 30 seconds.
In, out, answer, win. But not really. It's a character flaw of mine that means I often think very haphazardly, racing through to the end to finish more quickly at the expense of thoroughness. 9/10 times it makes no difference.
Still isn't good enough though. Neither would 99/100 or 999/1000.
It is going to take quite a shift in direction to relearn not so much a greater attention to detail (though that is important), but more different method of approaching the same situation.
What I should have done is taken the presenting complaint - tiredness - and worked from the ground up. Pathology in what systems can produce tiredness - CVS, Resp, GIT, Haemopoietic, Endocrine, Psychological (depression), etc; take a systems review of those.
As a very wise person once told me: The diagnosis is the end, not the beginning. Do the process right, and the diagnosis will fall out.
Start at the start. I have some unlearning to do.
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