Some Food for Thought
These were compiled by Clifton K. Meador, and edited a little bit for this site by Adam Seller. Read critically, and don't believe everything you read. Most importantly, consider how following these maxims could effect your clients' lives- for better and for worse.
There is no blood or urine test to differentiate a well person from a sick one.
The only way to determine if a person is well or sick is to:
Listen
Look carefully
Ask good questions and make a sound clinical decision.
There is no blood or urine test to measure mental function. There probably never will be.
The good clinician knows what he or she does not know.
If in doubt about dementia, do a mental status evaluation.
Learn to watch the skin color of the face.
Notice the change in respiratory rate as you discuss different subjects with your patient.
Give the patient permission to discuss unusual or deviant behavior. Do this in a specific manner: If you think the patient may be abusing laxatives say, "some people take only a tablespoon of milk of magnesia a day. Some take 2 or 3 bottles a day. How much do you take?"
You do not have to like a patient, but it sure helps.
Being a physician is a high privilege Do not abuse it.
The medical school curriculum is a poor format for learning anything about life.
Some patients are beyond existing medical knowledge.
Some patients are beyond all knowledge.
Some diseases are not treatable, but all patients can be given care.
Untreatable diseases should not be treated unless the patient agrees to be included in an experimental protocol.
Learn when and when not to call a surgeon.
Severe acute abdominal pain always requires a surgical consultation.
A good surgeon evaluating abdominal pain is equivalent to a highly sensitive and specific laboratory test.
An acute surgical abdomen is when a good surgeon says it is an acute surgical abdomen. There is no other test for it-however a CAT scan is a good idea.
Develop a list of physicians you trust and respect, nurture your relationship with them, and contact them about difficult cases.
Do not say "In my experience" until you have been in practice at least ten years. Even then, use the term sparingly or not at all.
When caring for a very sick patient, doubt all results of all tests.
Learn to check for the name of your patient an all laboratory and other test results.
Human biology and clinical medicine are not the same discipline. Human biologists and clinicians use very different thought processes. This is unfortunate for the patient.
The pathophysiology of the diagnosed disease should explain the patient's symptoms.
If it does not, you either have the wrong diagnosis or you are missing a second disease that could explain the symptoms.
Learn what treatments are futile.
If a treatment is futile, do not use it.
Never yell at your patients.
Don't get mad at your patients if they don't improve with your therapy.
Don't get mad at your patients because of their lifestyle.
Don't get mad at your patients.
If you do, get some help.
Avoid "organ" talk. Do not ask "How is your colon," or "your stomach?" or "Your sinuses?" or "Your heart?" or any other organ.
Ask how your patient feels. Do not let patients use organ talk. Patients know only how they feel or what they think. Insist on a language of symptoms, feelings and thoughts.
The mind readily sees and hears differences. It takes concentration and effort to see or hear similarities.
There are several kinds of what is called noncompliance. First, there are those patients who do not take your prescribed drugs because they did not understand the instructions. Learn to communicate in their language. Second, there are those patients who do not take your recommended drugs because they do not trust your opinions. Find out why. Learn to build trust and respect. Third, there are those patients who do not take your drugs because they make them feel bad. Learn to hear these people. They are often correct.
There are three types of questions in clinical judgment:
- The diagnostic question: What is wrong?
- The therapeutic question: What can be done about it?
- The ethical question: What should be done about it?
You cannot diagnose what is not in your differential diagnosis.
The four fundamental components of good clinical judgment:
- Intelligence
- Knowledge
- Experience
- Continuous critical analysis of results and one's self
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