We have been having a rash (pun intended) of dengue cases lately. I think my junior doctors are so preconditioned to the way of clerking suspected dengue cases that it becomes kinda automatic; which sometimes results in rather hilarious history presentations. Like this one for instance:
“This is a 83 year old Malay woman who complaints of 5 days of fever, associated with joint pains, generalised body aches, vomiting and diarrhoea on the first 2 days. She went to a GP and was given some panadol and antibiotics. She has no known medical illnesses. Blood test done outside revealed low platelets and so patient was referred here for admission.
She has no history of fogging in her area, no one else is sick in her family and she has no history of jungle trekking. She does not smoke or drink alcohol.”
For the life of me I can’t fathom why an 83 year old woman would want to go jungle trekking! I did ask the doctor why she asked that question to which she replied “just in case”.
Just in case of what? Just in case the old lady happened to be the royal consort of the Puteri Gunung Ledang?!! At 83, she probably had to be carried into the jungle, much less trek!
Medical education is a life long process. In its infancy, students are taught to ask a set of questions while clerking a patient and as they progress, we hope that they may develop the skills to distinguish which questions would be appropriate to ask. Alas, some times something goes wrong in the training process and we produce doctors who do not think on the job.
My personal aim is to get every single one of my students to think on the job.
Which reminds me of a history narrated to us by my professor in India regarding the same issue here. Here’s what he told us:
“This is a 22 year old man who fell down from the coconut tree while climbing up to pluck coconuts. He has broken his left tibia and fibula. He has no known medical or surgical history.
Family history: His uncle fell down from a coconut tree 5 years ago. His cousin also fell down from a tree 2 years ago. I am not sure what tree that was….
Funny but irrelevant.
Thurs, 100507 @ 0752; post call and it wasn’t too bad.