All entries for Tuesday 07 November 2006
November 07, 2006
Overall, today was a successful and enjoyable visit. I saw two patients throughout the visit, a young boy aged 10-12 years and a middle-aged woman.
The woman was my first patient, and she was presenting with a wheeze and a cough with sputum production following an episode of a sore throat a few days before, she was diagnosed as having a chest infection and was prescribed anitbiotics and steroids. I felt comfortable with the patient and ensured that I had kind and attentive body language i.e. smiling, gesturing that I was listening to her (acknowledgement), not sitting too close or ‘aiming at her’ – angle slightly deflected such that the patient does not have to look away to avoid eye contact. The purpose of the consultation was not to elicit the required information, but just to get a hang of the communication skills required to acquire this information.
The doctor was very efficient in his analysis and inquiry, he repeated important issues to clarify them, and also put a strong emphasis on the family/social history, which I usually forget! The patient started to cry towards the end of the consultation, and the doctor comforted her with a soft voice and reassured her that these illnesses can sometimes get on top of people i.e. her being emotional wasn’t that much out of the ordinary!
My second patient was a tad more difficult, as he was quite young. Every question I asked was replied with a one word answer, the lad wasn’t generally that chatty – I’m sure I wasn’t at that age. So the main issue here was that there were silences quite often, and I was struggling to close them – it was obvious here that the lad wasn’t going to use these silent opportunities to speak his mind – his mum was there as well, and he was only presenting with an itchy skin rash! So there probably wasn’t much more than met the eye here (but yes, you never know for sure), unlike the first patient, whose sudden breakdown was quite unexpected.
One very important thing is to be confident – even when you don’t have the foggiest idea what is wrong with your patient/what to do etc, just explain the situation and get on with it, but be confident. Your patients will lose trust fast in a doctor who is shaky-voiced and unsure, I would.