The last two years of the graduation are most interesting and most difficult too. This is the time when the students start wearing white coats, hanging the stethoscope around their necks or in the pockets of their coats and start getting the feel of being in medicine. Small groups of students are posted in different rotations like internal medicine, surgery, pediatrics, orthopedics, ENT, Ophthalmology , Obstetrics etc.
We would suddenly be rushing behind the residents and the senior teachers, requesting them to teach us. They of course would be busy in the patient care. Sometimes, it would be a long wait when someone would directly teach us. Most of the time the teaching would be in form of attending the long rounds which the senior doctors would take along with the residents and we would just be the bystanders.
The patients who attend medical colleges are usually smarter than the students themselves. Those with chronic illness are already too much in suffering and to add to it, the daily rush of students rushing in and out of the wards does not add anything to reduce the pain. At times the students trying to hone their skills becomes more of an irritation.
History taking is one of the key skills in medicine. This is necessary not just for passing the exam but afterwards as a practicing doctor it is one of the most important skill. The fundamentals of this basic step is the doctor patient confidence. A doctor who makes the patient feel comfortable and cared for is able to let the patient unburden himself by telling him all about his complaints, how it started etc. We as students forgot this aspect. We as a group of students would flock on a patients bed and the patient who wanted to just rest would most likely feel uncomfortable. We would bombard him with questions …since when do you have it, what were your first complaints, how did it progress? Do you have any other chronic illness? Do you smoke? Do you drink? Do you have any family history?
This would not stop there. After that we would start our skills of palpation, percussion and auscultation. We were the inexperienced medical students and now when I look back I feel how uncomfortable the patient would be with multiple hands touching here and there, all trying at once to experiment and hone their skills.
At times, one of the students would be caught and assigned to prepare the case and present for discussion the next day. Case presentation meant taking the history, examining the patient and then coming to a differential diagnosis. The student would very diligently prepare for the case in his limited knowledge and then caught next day in front of the whole team. At times, the patient would be then chuckling at the ignorance of medical students.
I remember the grand history taking during my final year surgery exam. We were Hindi speaking people in the heartland of Marathwada. I was able to learn only a little Marathi and that too could understand only if spoken very slowly. The patient i received could speak only the local dialect and thus there was a total communication gap between him and me. He had a huge lump on his back which had been operated before. All I could make out was, that it had just been biopsied before. The examiner just looked at me helplessly and i was pretty sure i would flunk in surgery. It was a great relief when the results were out.
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Read the previous post here A for Anatomy dissection Hall B for Biochemistry equations Coffee and late night conversations D FOR DRUGS ( PHARMACOLOGY ) E for Exhausted Doctors F for Forensic G for Genius and Not so Genius!