Showing posts with label Ethics. Show all posts
Showing posts with label Ethics. Show all posts

Tuesday, April 2, 2019

Asking Questions

History taking in medicine is science just as much as art. Here are some tips.


Open questions: ‘How are you?’ ‘How does it feel?’
The direction a patient chooses offers valuable information.
‘Tell me about the vomit’
‘It was dark’
‘How dark?’
‘Dark bits in it’
‘Like bits of soil in it’
This information is gold although it does not cast in the form of coffee grounds.

Patient-centred questions: Patients may have their own ideas about their symptoms, how they impact and what should be done. This is ever truer as patients frequently consult Dr. Google before their physicians. Unless their ideas, concerns and expectations are dealt with, your patient may never be fully satisfied with you or be fully involved in their own care.

Considering the whole: Humans are not self sufficient units; we are complex relational beings, constantly reacting to events, environment and each other. To understand your patient’s concerns, you must understand their context: family, friends, work, dreams and fears. A headache caused by anxiety is best treated not with analgesics; but by helping the patient access support.

Silence and echoes: Often the most valuable details are the most difficult to verbalise.
Trade secret: the best diagnosticians in medicine are not internists, but patients. If only the doctor would sit down, shut up and listen, the patient will eventually tell him the diagnosis.
While powerful, silence should not be oppressive- try echoing the last words said to help your patient vocalise a particular thought better.


Closed questions: Permit no assumptions. Take no subtle information for granted. Let the patient paint you a picture.

Questions suggesting an answer: The doctor’s expectation and hurry to get the evidence into a pre-decided format have tarnished the patient’s story enough to render it useless.

- Ashish Singh

Wednesday, April 5, 2017

Fisher's Rules.

Hello Everybody!

So today I will be telling you guys about the “Fisher’s rules” that I came across while striving to develop good clinical skills while doing my internship!

So these rules are basically clinical maxims collected from observing C. Miller Fisher, a clinician of legendary diagnostic acumen. Some of these axioms are particularly helpful to bear in mind and are relevant for Clinical Reasoning and useful as diagnostic Principles.

So here we go, while seeing the patient for the first time we better keep the following 6 rules in our mind.

1) In arriving at a clinical diagnosis, think of the five most common findings (historical, physical findings, or laboratory) found in a given disorder.

If at least three of these five are not present in a given patient, the diagnosis is likely to be wrong.

2) Resist the temptation to prematurely place a case or disorder into a diagnostic cubbyhole that fits poorly.

Allowing it to remain unknown stimulates continuing activity and thought.

3) The details of a case are important; their analysis distinguishes the expert from the journeyman.

4) Pay particular attention to the specifics of the patient with a known diagnosis; it will be helpful later when similar phenomena occur in an unknown case.

5) Fully accept what you have heard or read only when you have verified it yourself.

6) Maintain a lively interest in patients as people.

I found these extremely useful while seeing patients in real and so thought of sharing these.

Medicine in practice is more than just Studying the Standard textbooks, It's an Art that we should all strive to Master,so we can help our patients better.

Its a long journey ahead... Let's Learn Together!


Friday, December 9, 2016

A case on Medical ethics

Hello Awesomites!

Today I am gonna discuss with you a simple case based on medical ethics. A Forensic Medicine professor asked me in final viva last year. So here it goes...

Tuesday, July 5, 2016

Order of decision making

Ideally, a doctor discusses the available options of treatment with the patient, the patient makes a decision and informed consent is obtained.

However, this may not be possible on every occasion and it is the physician's responsibility to ensure that a decision is made that would be what the patient would have wanted (if the patient does not have the capacity to make the decision himself/herself).

Friday, January 15, 2016

How to Behave like a Good Doctor? (Part 1)

                     Anybody with a hard earned MD/DO or MBBS(MBChB/BM/MBBChir etc all fall here) can be a doctor. But not every doctor is a good doctor. Not every good doctor can present themselves well and behave as a doctor.
Hello awesomites, I’m Jay here, once again with some insights on How behave as a Doctor in a Clinical setting. Today we had a discussion in our Medical History Lecture about this, I’m basing the article on that. This part 1.
  1. Attitude
You should have a proper attitude as a doctor. In front of your patient, you should look confident. You should not be