I’m now on my third week of virtual clinical clerkship and today was my first day on the Department of Pediatrics. Our first task was to write a history and physical examination of a neonate based on a video shown to us.
I have never enjoyed writing history ever since my 2nd year in medical school. It is a tedious task. However, I am fully aware of its significance in the practice of medicine. A thorough history and physical examination would entail 80% of a physician’s decision on arriving at a correct diagnosis. Ancillary laboratory procedures only account for the other 20%.
The founding fathers of medicine have never grew weary of emphasizing the importance of complete history and physical examination. From William Osler to John Snow (the Father of Epidemiology) even up to Sir Arthur Conan Doyle (the author of Sherlock Holmes, and yes he is a physician). A doctor who does not know how to conduct accurate history taking does not deserve to practice medicine.
I have been a fan of AC Doyle’s theory of the Science of Deduction. I have believed that this principle is just a more fancy term to what doctors call a clinical eye. I have also been training myself how to keenly observe and pay attention to even the pettiest detail a patient presents to me. This is the secret to a successful conduct of history taking.
But despite of years of writing and interviewing and practicing the principles of this bread and butter of clinical diagnosis, I still couldn’t seem to perfect it.
Today, I received a grade of 75 on a Neonatal History I submitted just because of one simple mistake. I used a layman’s term in the History of Present Illness instead of using its counterpart medical term. I wrote “The bag of water broke upon delivery” instead of mentioning “The membrane ruptured upon delivery”.
I hated myself today because of that. I cannot afford to make the same mistakes soon when actual patients’ lives depend on this delicate practice which I cannot seem to master. My anxiety has overtaken me again today but I must and have learned to overcome it.
I have submitted four long outputs on our online platform about 10 minutes ago. I spent the entire day perfecting each sentence because I told myself I cannot afford to make mistakes again. Am being too hard on myself? Is attaining for perfection — this kind of perfection — not good?
I have already attached the files, one click away from submission, but I had to check and recheck and recheck for mistakes. Is my grammar correct? Have I followed the correct format? Did I attach the correct file? Am I on the correct web page for submission? Am I still within the deadline?
Anxiety was controlling me. But I have let it go.
I may have done several mistakes today but I know I have learned through them. Tomorrow, I’ll rise up again — make mistakes again, but learn to never give up.
There is no more difficult art to acquire than the art of observation, and for some men it is quite as difficult to record an observation in brief and plain language.William Osler
You see, but you do not observe.Sir Arthur Conan Doyle
I’m sleeping now but my professor’s words are still resounding on my head. Think fast…Act on your feet. It’s better that you think and observe intuitively.