Tuesday, 7 August 2007

Medical Student Visits and Ways of Thinking

This week and last week has seen the usual influx of medical students from throughout Japan coming to see how this hospital works.

I have as a result been very busy with my daily rounds teaching history and physical examination to the students so that they can also understand the patient problems.

When I am asked by Residents what the problem is, I naturally produce a differential diagnosis but I then throw the question back to the Medical students. I usually get but only a few answers.

I am aware that in Japan, because of the hierachical structure of the senior doctor to the junior that in some cases what the senior doctor says is final and with little or no questions from the juniors / medical students as it might be seen as embarrassing or insulting.

Well, I do not mind questions. I think questioning seniors is good. In fact, fresh medical students / junior doctors fresh from medical school can sometimes have the right answer as they know the most uptodate information.

Sharing of ideas and challenging why a diagnosis has been made allows all the members on the round to understand the thought process behind diagnosis. By questioning the senior doctor allows everyone to understand and to find out the evidence / experience of the senior doctor and hence, all can learn from this type of interaction.

I had a discussion just yesterday with several medical students and I advised them that they should always read about the patients that they see. In doing so, they truly learn about the conditions and the associated problems, workup and treatments.

As a medical student / doctor you need to read to fill in the gaps in knowledge that everyone has. No doctor is perfect-- except perhaps Prof Tierney ! :)

By reading, one can learn about the evidence base of current diagnostics and therapeutic measures and why old treatments lose or regain favour etc...

Never just rely on the notes taken at university as they soon become out dated and moreover, they are sometimes opinion of the lecturer rather than based on evidence and fact.

The take home message today is always question in your own mind what is being said to you and never just accept that it is correct. Go away and read about it and decide for yourself if that is correct or not. In so doing, you will grow as a physician and become better diagnostitians.