Sharpening one’s clinical acumen
Whenever I have the luxury of time, I try to spend a little more time doing teaching rounds with our medical residents and cardiology fellows in training. They’re supposed to learn from me as their consultant but many times, I’m the one learning from them.
Recently I made rounds with Doctors Tina Roldan and Sweet Tappan, two of our senior residents at the Manila Doctor’s Hospital (MDH). And it’s heartening to see how they have matured professionally in a matter of a few years. They were very exhaustive in our patient’s history-taking, getting information I failed to elicit myself when I interviewed the patient; and their physical examination (PE) was equally thorough, making them confident to come up with a reasonable admitting impression even before the laboratory exams were done.
Young doctors like Tina and Sweet boost our dictum that with a good history and PE, a physician can already come up with a correct working impression 85 percent of the time. Of course, laboratory exams are still needed, not only to confirm our diagnosis but to get more details on the disease we’re trying to treat in the patient. But a good physician will already have a good working impression which would allow him or her to initiate treatment even before the lab results are obtained.
New lab tests
Last week, I took part in a debate during the annual convention of the Philippine Heart Association on how important new laboratory tests are in guiding the physician on how to manage their patients. I took the con or negative side, stating that some of these laboratory tests are too expensive, and not cost-effective in the local setting, or in any country which may be considered a low-resource setting.
Some of these tests are nice to do if patients could very well afford them, but if they couldn’t due to financial constraints—like the majority of Filipinos—overreliance on laboratory exams does not define an astute physician who truly cares for his/her patients.
In some instances, too, the lab results can give equivocal findings which can mislead the physician. In such instances, one just has to rely on his/her clinical acumen to decide how best the patient could be managed. We’ve always emphasized to our young doctors that we should treat the patient, not the lab results. When there is a disagreement between one’s clinical findings and the lab results, the perceptive and sharp physician would rather rely on his/her clinical findings.
The medical consultants and residents of MDH have been organizing yearly postgraduate courses for doctors, nurses and other healthcare professionals; and these courses aim to give practical take-home treatment guidelines and other pointers that can help sharpen one’s clinical acumen.
The courses also aim to make doctors and other healthcare professionals holistically equipped in dealing with various clinical dilemmas encountered in everyday practice.
“With a fast-paced changing world, it should be our goal as healthcare providers to not just be good in our respective fields but to be great in our profession, and relevant to our colleagues, our patients and our country,” Tina and Sweet told me.
Led by its indefatigable chair, Dr. Petrarch Bravo, the MDH department of Internal Medicine is holding its 12th postgraduate course titled “IM GREAT: Goals, Risks, Evidence, Approaches, Therapies” on June 18-19 at the Diamond Hotel, Roxas Boulevard corner Dr. J. Quintos Street, Manila.
The topics were painstakingly chosen by the scientific committee, headed by Doctors Karla Fernando and Clariza Santos. Each topic is interesting and relevant to the medical community. Topics include gout, goiter, arrythmias, anemia, HIV, chronic obstructive lung disease, hepatitis, tumor markers, obesity, recreational drugs, and on the lighter side, power dressing and grooming for doctors and healthcare professionals.
The lectures will be made simple but with a lot of practical take-home pointers. This will be especially meaningful for those in general practice, family medicine, nursing service and other allied healthcare service.
The course organizers have also invited a select pool of seasoned speakers and resource persons, who are well-known and respected in their respective specialties. Among them are Doctors Nemencio Nicodemus, Giselle Gervacio, Epifania Collantes, Raymond Alonso, Eric Amante, Clariza Santos, Sonia Salamat, Dessi Roman and Pia Reyes, lawyer Carlo Alcala, Doctors Russel Villanueva, Janus Ong, Aileen Wang, Karen Villanueva, Ging Racaza, Kathy Go, Roberto Mirasol, Maidenlove Raguero-Paner, Alvin Mojica, Olive Quizon, Allan Gumatay and Rogelio Tangco.
Those who are interested to attend the course may contact 0917-5596161, 0998-5580455, 5243011 local 3550; or you may e-mail [email protected] It’s always good to invest some time and money to become better professionals. I strongly recommend this course to our healthcare colleagues.
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