The clinical medicine logic

The physician works in a large frame of 3 pillars: the preventive medicine, the diagnostic medicine and the curative medicine. From a broad practical view the physician’s job is mainly in the curative medicine pillar.

The clinical (curative) medicine logics may be thought of as:
1- Adjunctive medicine
– analgesic, sedative, anxiolytic
– Mood modifiers
– Psychoactive agents
2- Casual medicine
– surgery
– invasive diagnostic and therapeutic interventions
3- Regular medicine
– nutrition
– common nonspecific agents: laxative, purgative, emollient, carminative
– specific medical agents
– antibiotics and antimicrobials
– anticancer agents


The physician’s guide

the physician's guide

The physician’s guide is an indispensible tool to summarize basic medical and clinical knowledge and experiences. It should be concise, easily demonstrable, regularly updated and greatly physician-specified (self made).

Here is a personal view of such important medical tool.

The Hippocratic Oath

Section 1: normal values (pediatrics: growth milestones or curves, caloric and fluid requirements and calculations; CBC; hemoglobin electrophoresis; plasma electrophoresis; liver function; kidney function; urine; stools; semen; hormones; electrolytes; arterial boold gases; and ECG findings).

Section 2: preparation-oriented drug index (topical formulas: skin, eye, ear, and nose; tonics and food supplements; antimicrobials: antiseptic, antibiotic, antifungal, antiprotozoal, and antihelimenthics; analgesics and antipyretics; antihistaminics; corticosteroids; skeletal muscle relaxants; antispasmodics; antihypertensives and cardiac agents; hemostatics, hypoglycemics; neuropsychiatric agents (sedatives and hypnotics, anticonvulsants, brain stimulants, antidepressants, antiparkinsonians); and beauty preparations (shampoos, cosmetics, soaps, etc.).

Sections 3: natural foods and herbs – sorted alphabetically – and their uses (basilica, chamomile, garlic, green tea, onion, thyme, etc.).

Section 4: medicines’ doses and instructions tables (neonate, child, and adult).

Section 5: crude models of medical prescriptions (orthopedic, eye, ear, nasopharyngeal, dermal, gynecologic, oral, cardiac, digestive, liver, renal, respiratory, and neuropsychiatry).

Section 6: medical algorithms (pediatrics: infant of diabetic mother, muconial aspiration, low birth weight, prematurity, neonatal jaundice, respiratory distress, etc.; adults: HTN, DM, bronchial asthma, cardiac asthma, DVT, diabetic ketoacidosis, hypoglycemia, stroke, etc.).

The ten golden rules in rescuing the (medically) troubled

ten golden rules

Situations in which medical care or advice should be provided vary considerably as regard place, time and the extent of the medical problem, i.e. patient’s state as regard consciousness, cooperation, presence of patient’s relatives, etc.

Here are 10 rules that I wish to conclude from my experience in the clinical field.

1- The sense of being attended: the health care provider should stress and make sure that the patient perceives that a good medical care is being present. This would be achieved by speaking gently and confidently with the patient and/ or with the relatives. The doctor may state clearly that he/ she would have no problem to see the patient for free when the patient’s condition money-wise is not favorable. The doctor should be cautious as much as possible to protect the patient from possible negligence by his/ her relatives.  In case of a patient with perturbed consciousness the doctor would call the patient by his/ her name (if known) and hold the patient hand warmly.

2- Resort and handing: the doctor would have preliminary assessment of the medical problem, and recalls his/ her knowledge and may need to find some source as a book or contact a colleague for consultation. The doctor may have to urge for a referral to a more experienced doctor.

3- Fulfilling continuum: the doctor may inspire that human body is one continuum with dynamically operating modes and proportionately distributed components. This should be very useful in determining the dose, rate, and intervals of the medicines to be used.

4- Hierarchical approach: the management plan should be almost clear from the beginning. The management should assume a hierarchical concept as regard the relevance of interventions/medicines to one another from one side and to the human body function from the other side. It should start from natural means to encourage the self-curing power in the patient, e.g. warming the patient, changing posture, etc., and proceeding from a less invasive to more invasive.

5- Multi-footed treatment: this means that using more than one point or target in the treatment, if allowable, would help reach a more smooth response with less likelihood of misfortune. This integrated approach would allow less and more tolerable medicine doses.

6- Proof tracking:  this means that on following certain treatment the doctor keeps an open eye checking back and forth for the consistency and appropriateness of a given step in the management for a possible need to change the treatment plan.

7- Case cliché: by the time the medical condition is being resolved the doctor should formulate a clear definition of the case (diagnosis) and inform the patient or the relative(s), orally and/ or in writing.

8- A Gift-outcome-art: this means that the outcome of the medical care is quite unforeseeable. Here, the outcome is usually expressed as percentages or probabilities and not as a definitely individualized result.

9- Non obligation: the medical care should not bear any obligation from both patient’s and doctor’s side.

10- Medical ethics: the doctor should be aware of and fulfilling the medical ethics applicable to the particular medical problem being managed.

Cherchez la stagnation

cherchez la stagnation
Stagnation is a non-medical word that may form a basis for a myriad of medical problems. The human health is dependent on a balance between seemingly opposite processes like wear and tear, and production and disposal. Stagnation in this medical context may manifest clinically as bodily and/or psychic illness such as abdominal pain and headache or anxiety and fears, respectively. Here are examples of medically relevant stagnations: emotional, creational, moral, social, physical, sexual, and instant.

Emotionally stagnant person is one who can’t express his/her feeling and thoughts. Creation includes free thinking, learning and bringing ideas into light. Morally stagnant persons are those who insist to do good while they miss support or encouragement from other people. Social prosperity is a matter of acceptance, tolerance, equality and fairness. A body that moves either by doing manual work or sports is likely to be physically cheered. Sexual stagnation may occur due to lack of regular and satisfactory relationship. By instant stagnation I mean a physical disease like biliary or urinary obstruction.

A good physician should consider the pivotal role of “stagnation” in health derangement and learn about the means of its detection and repair.