The clinical session algorithm

The clinical session algorithm

The excitement and challenge of the medical session are not to overlook especially for newly practicing physicians. Red cheeks, heart knocking, hand sweating and even head whirl may be typically experienced by many doctors even by quite experienced ones. The reason for such clinical session tension could be overestimation of the job and/ or lack of the successful scheme (algorithm) for medical management.

In this essay, I wish to emphasize that the tactful handling of medical care including clinical session is a matter of training and learning where the inherent talent influences the length of time necessary for such clinical mastering. About clinical session or examination questions regarding its duration, steps and order plus precautions and ethics are indeed worth noting. These together will shape out what is known as ‘the clinical sense’.

1- Context: what is the context of the clinical session?

By clinical session context I mean the time-place frame of the patient’s presentation. These circumstantial provisions may have influence on the clinical session as for professional progress and patient-doctor expectations. Besides care about medical perfection and contentedness the question whether a medical fee could or could not be considered can be quite sensible.

2-Patient type:  what kind of patient is this?

Broadly speaking patients may be seen as either chattering or serious. Because in some cases such definition and judgment of the patient may take time for the sake of fairness and respect to all patients, this question should be considered from the beginning and throughout the clinical session.

3- Presentation: what level of urgency does this case have?

The level of urgency may be graded in 4 levels: 1) life threatening problem, 2) potentially ailing problem, 3) naturally resolving problem and 4) intervention sparing problem.

In order to adequately define the level of urgency good knowledge and appreciation of the possible presentations (complaints) in the different diseases is required. For example, headache can be a symptom of different diseases like stress, constipation, muscle inflammation due to cold for example, fever, sinusitis, high blood pressure, etc. The level of urgency and, hence, appropriate management will vary for the same complaint from one disease to another.

4- Management plan: what to do for this case?

This question is answered at 3 levels: 1) immediate plan, 2) remote plan, and 3) Follow up plan.

The immediate plan is instituted for either therapeutic or prophylactic aspects. It can be omitted when there is no need for it or when the case cannot be yet well judged. Referral of the patient to a more experienced colleague and/ or medical care center is also possible option for immediate management plan. The remote plan may form a further management step or follow certain preparation with or without medications. The follow up plan can be needed for life long or relatively time lasting cases.

5- Clinical session closure:  what to do when you are done?

Considering the appropriate ethics, time and progress of the clinical session, the closure of the session should be smooth and well prepared ensuring that all the medical instructions and treatment plan given to the patient in writing and having the required and ‘allowable’ contact information taken by both physician and patient.

Why Don’t Mosquitoes Spread Ebola?

Mosquito Research and Management

13717624625_cd5f3df570_zAuthorities are quick to remind the community that Ebola virus is spread by blood and bodily fluids so it is hardly surprising that many are asking, “can mosquitoes spread Ebola”?

The 2014 Ebola outbreak in West Africa is the largest in history. As of mid-October, there have been approximately 9,000 cases and 4,500 deaths. The World Health Organisation warned that the infection rate could reach 5000 to 10000 new cases a week by the end of the year.

The virus is primarily transmitted from sick to healthy people by blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen). In addition, objects contaminated with the virus (including needles and syringes) and direct contact with infected animals also play a role. Given this knowledge, it is not an unreasonable question to ask if blood feeding mosquitoes could spread the virus from infected…

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Not Perfect, But All Right

upwitscreek

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2014 has not been kind.

On a cold, snowy day in January, when my husband was in Tokyo, my 10 year old son received a lifelong sentence. It began with a sick visit to the pediatrician followed by another sick visit to a gastroenterologist. As I sat across from this woman, who I disliked as soon as she entered the room, I could not imagine that my son’s world was going to permanently change. After a brief examination and a denial of all symptoms from which she was sure he was suffering, she stoically pronounced “he has Crohn’s,” which only made me hate her more than I already did. She prescribed antibiotics and advised that he would need to be examined under general anesthesia.

That night, my son slept in my bed. I spent most of the night feeling his forehead, making sure he was still asleep, plotting the death of…

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