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Clinical Knowledge

Developing clinical judgment is a process that takes years of learning and experience. I am approaching the 4 month mark in my clerkship year and things are starting to make a lot more sense. As more and more of the knowledge I learned in the first two years is translated into clinical decision making at the bedside, I appreciating more than ever the process of learning.

In preclinical years, you build your foundation of medical knowledge, often times the boring stuff. The medical terminology, gross anatomy, physiology, pathophysiology, and other basic science knowledge. I thought most of this knowledge was irrelevant when I learned it, but as I see more patients and cases, the trivial knowledge becomes useful information.

As you learn how to manage diseases, you also learn the clockworks of how to do things. Writing notes, prescriptions, trade names, dosages, prices, side effects, and other nit picky information that you didn’t bother in the first few years. It’s not hard work. After a while, things get memorized. The treatment of a UTI becomes just like a formula you learn in physics class. Not hard, but necessary so things can be done.

And finally you learn about evidence based medicine (EBM). I’ll be honest, the first two years, it was hard to grasp what EBM meant and how you could use that knowledge. But as you start reading guidelines and review articles, you realize that there is an awful lot of things that we just don’t know. Is one drug better than the other? How do you know that? Which symptoms should you ask about, which one has a strong predictive value? Which test should be ordered, what do you expect to find, and how much can you rely on the result to be true?

I used to find EBM stuff pretty boring but now it’s probably one of the most stimulating things to learn about. It’s the frontier of medicine, it’s NEW knowledge.

And finally to become an effective physician, you must master the history and physical. It’s a skill they teach you on the first day of medical school that will be relevant in all your future patient encounter. Learning how to listen to answers and communicate effectively. Knowing which questions to ask, when to ask and how to ask them.

Overall, third year has been great so far. It’s intellectually stimulating and I’m having lots of fun on the wards and in the clinics. I’m reading more than ever on my own time, from old and new texts. I am updating my knowledge every day and sharpening my history and physical. Motivation is at an all time high.

Now… if I could only find some time to eat, sleep and exercise…  =p

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  1. Michael
    Michael November 24, 2010

    This is out of the blue, but if you were given the opportunity to shadow a physician in a clinical setting would you be asking questions? Or just quietly observe and make notes in your head.

    Lets assume you were weren’t in med school yet so your knowledge in this field isn’t as great as you would like.

    • medaholic
      medaholic November 26, 2010

      I would do the following:
      1) read around what you see, so you can have the background knowledge to understand what’s going on.
      2) ask the physician afterward any questions you might have. if you’ve done your homework and know something about the topic and the basics, you can ask questions that i’m sure the doctor would love to answer. You can always open-ended questions too.

      eg in a family clinic. DON’T ASK: What is diabetes? What are the symptoms? What is X drug? etc (stuff you can look up)
      GOOD OPEN QUESTIONS (generic but can stimulate conversation): What are obstacles that prevent patients from having good control of their sugars?
      CRITICAL THINKING QUESTIONS: Why/when would you switch that patient’s treatment? Do you manage their DM differently if they have other conditions?

      If you don’t know any knowledge, questions about ethics, patient feelings & attitudes, personal experiences work pretty well.

  2. Joe
    Joe November 25, 2010

    This is really amazing. It looks like you’ve had an epiphany along your journey through the medical training process, where everything seems to fit into place. Keep up the good work.

    • medaholic
      medaholic November 26, 2010

      Thanks. It’s not so much as an epiphany as finally seeing how all the pieces of the puzzle fit together. It’s really satisfying to see that what you learned has a real application in the real world.

  3. Michael
    Michael November 26, 2010


  4. Ted
    Ted August 21, 2012

    Lots of cocksucking to be had during clinical rotations. Impressing is first, learning medicine is second.

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