How not to answer a question

Achievement unlocked: Completed first surgical placement
Status: Acceptable

Some consultants like you to stay quiet if you don't know the answer, some like you to take a guess because "I don't know is never right". But all of them like you to think systematically, to have a pre-programmed structure to your answer. There are some classic questions a surgical consultant will fire off and expect a quick, concise answer in reply - answer that can only be achieved by applying logical, systematic thought.

When we're taught this way of thinking it is generally with a smile on the face of the lecturer and a remark about how you can use the answer to avoid actually having any specialist knowledge in the topic or in actuality, having an answer to the question. If that sounds a little convoluted, allow me to demonstrate:

"What are the complications of this surgical procedure?"
"Complications of surgery can be divided into immediate, early and late, and further sub-divided into specific to a given operation or general to all surgeries. Immediate complications arise during the procedure or in recovery, early within 48-72 hours, late within weeks of the procedure..."

Do you see how that answer isn't an answer at all? And how it is completely right at the same time?

At first I thought it was a technique to bore the consultant and get them wave you into silence, firing off the next (and generally harder question) at the student next to you. But then when I thought about it a bit more, I realised this is such a useful way to manage your knowledge. Rather than having a randomly assorted list of things, you can partition them off, divide them up to help guide your care and treatment modalities with a clear understanding of the most likely cause and the relative seriousness of the complaint.

Whilst there having been important take-aways from this placement, such as the fact I don't think I'm going to be a surgeon, or how busy and yet elegant the anatomy of the hand is, the notion of systematic thinking and how to apply these kind of techniques to make me a better doctor is my top learning point form the past six weeks.

Another mnemonic for you med students out there

A new week, a new case, same old stuff to run through. Once you have your disease of the week, you can go through all the important bits of it, systematically.

DR DEAC PIMP

Definition
Risk factors

DDx
Epidemiology
Aetiology (apologies to my transatlantic cousins!)
Cause

Pathophysiology
Investigations
Management
Prognosis

Runner's Hip

What is this hip pain?

So nearly 4 weeks ago I was finishing up a 6 mile run and there was a sudden, sharp pain in superior lateral aspect of my thigh, which made walking so painful I figured I'd pushed myself a little too hard and I had a few days of hobbling.

Like I say, 4 weeks ago.

TFL to its friends

I carried on hobbling and stopped running and felt annoyed. It got slightly better after a couple of weeks, but one running session took me right back to square one. So, off I went to the GP, running through SOCRATES in my head:

S - Site - Superficial to the greater trochanter

O - Onset - 4 weeks ago

C - Characteristics - Hurts when I run, not much else

R - Radiation - Nope

A - Alleviation - Not running (!)

T - Timing - Uh, no

E - Exacerbating factors - Again, running/ not running

S - 2 normally, 8 running

My GP went through a range of motions with me, poked and prodded and said "You've damaged a muscle". Indeed. As it wasn't constant and didn't limit my range of motion, we could rule out any joint damage or ligament-related hilarity, thankfully. Nope, the culprit is Tensor fasciae latae. So now I'm taking a further 2 weeks off running and chowing down Naproxen 500mg BD in a bid to tell my body to calm the eff down with the immune response already. In general my GP was against the idea of running "Swimming, yes. Cycling, yes, Rowing, yes. Running? No, no, too much impact", but I think that was idealogical rather than lifestyle advice!

Another space filler

Urgh, I am having trouble finding the time for a proper post, but here's a little something for this evening: The Differential Diagnosis

There as many ways to do this as there diagnoses (PRO TIP: It's never Lupus, but it might be TB) but the one my PBL group has settled on for the next few weeks is the acronym, Investigations - a like so,

Idiopathic/ Iatrogenic
Neoplasm
Vascular
Endocrine
Structural/ Mechanical
Traumatic
Inflammatory
Genetic/ Congenital
Autoimmune
Toxic
Infective
Old age/ Degenerative
Nutritional
Spontaneous/ Social

And as for history taking, I'm yet to find a good one, so I just end up humming...