Today was my first preceptorship session in PPS-3 with an infectious disease specialist. Our group of three students saw patients in the veterans affairs hospital with all sorts of conditions, and for today’s session, we attempted to draw out the history of their present illnesses.
We learned how to do this in PPS-1 months ago, but it was a little different this time. In the past, I interviewed patients at their initial visit (ie, what brought them into the hospital/clinic?). Today, we saw patients who had already been treated and were now recovering. It was good to see that all of them were doing much better after being admitted. 🙂
One thing I particularly enjoyed about the session was the preceptor constantly getting us to focus on the patient’s description of what happened. These patients have been bombarded with exams and diagnoses since being admitted, so asking them “what initially brought you in?” is followed by responses like: “Well, the first doctor did a CT and said I had ‘x’, and the second doctor gave me medication for my ‘y.'”
To practice good medicine, we have to ignore the biases of other physicians and constantly go back to the patient’s account of his/her chest pain, headache, abdominal discomfort, etc. What was it that made your first doctor order that MRI? What made your endocrinologist switch meds to treat your diabetes and hypertension? Why did you lose weight without intending to do so? Why? Why why why?
These questions empower us to analyze the symptoms and draw our own hypotheses without potentially being misled by another physician’s interpretation; when the diagnoses of multiple physicians coincide, they just add credibility to each other. And that’s always a good thing for the patient.