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I have been concerned for some time by the appropriate time lapse needed for the formation and qualification of physicians. It is always quite long but how long should it be? In parallel to this question another not less important view arises about a standard “medical qualification consensus”. The latter view proposes that there should not be a difference in the medical knowledge and training skills among all doctors. I remember the “difficult” time I had in my medical courses when there were a lot of things to understand, memorize, and interpret and to fear from.
I did not by that time know that there could be a problem in the learning process and what it could be except that I was always tired and life could just lose its delight; I am a future doctor! The door is thus open for each one, medical student, to build and adopt personal idea and trace an “emergency exit” for such apparent medical career crisis. Some sought a solution in simply memorize to preserve a respected position as a university staff member as best thing among all bad options. Some others diverted to international certificates for both recognition and enhancement. The third group made every possible effort to escape the GP label to a specialist or assistant specialist title. In many of those examples the solution was almost superficial and cosmetic. The outcomes of the medical service provided by many medical colleagues are, therefore, almost random and the learning curves are quite flat too. The typical query: doctors are guilty or victims?
The proposal for an efficient and working medical formation may find its success in a well designed medical qualification consensus. There could be no more need to read whole books or to sprain your mind to memorize “a line” within the covers of several hundred pages book just because it may come in a question. The consensus should be laid down and agreed upon by notable and experienced scholars and practicing physicians such that a whole subject, e.g. physiology, may not exceed 50 pages in its neatest and leanest form. A subject like anatomy, e.g., should not be such frustrating for a green student mind with all details in one menu, but rather served in pieces that are totally clinically and research-wise relevant. In this regards building models and simulations and encouraging learning maps and subjective imagination should be also very helpful.
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.
When I decided to become a physician I was keen only on that title and profession that suit my ambitious character and passionate nature. As time passed over and over I am aware now that I was and had to choose a way of opposites. Such opposites may contrast extremely in real and fancy and in action and the proposals, and – at the same time – they may reflect an example of an honest and working counter mix with fine thinking and naïve reflection.
I don’t see yet the value of wearing eye glasses as some may have advised. I should not argue that my sight is as sharp as that of a teenager but really I am still can do without. Eye burns and scratching could come from time to time for some kinds of stress and I don’t like to overestimate such temporary complaints. Wearing eye glasses is sometimes fashionable or stylish but I am still stuck to my early days of fabric independence. I do not succumb to the must-study seasons and the sleepless nights but like to run, swim and shape muscles. And though I am deeply not a dress model, it can happen to become a one when the situation dictates it. By the same way, I am not such all-in-one person but when it is needed it can come to many things; interpreter, writer, poet, painter, etc.
The very serious themes of the medical care among the house corridors, noises of wheel chairs and smell of antiseptics and the different wounds could hardly capture my fancy as a streaming sailor or a floating sky diver. I believe in Shakespeare, appreciate Newton and admire Einstein. Being a qualified physician I am supposed to be a scientist too. I know I am neither hindering death nor helping it. Death is a destiny and I try to bring about a fortune of health and wisdom. But do not then wonder if I am a physician or a priest.
I am so simple that I care about every detail and decide for the one that touches my genuine defects.
It is nice to meet and know good people in a quite formal context, when customs and ethics are well applied and respected. You will like a smile, praise a shape or figure and admire a character. And so as a habit you will find somebody to like and almost find an excuse for possible light mistakes or a triviality. Sometimes, it is even more exciting to know about your idol something, but not so formal this time, as I would like to tell now about my amazing super physician. In one word I would like to shape out my physician as a mere human. A human who may have much cares about himself and about other people as well; who can make mistakes and suffer these terrible pains of conscience and self-criticism, and who may have chronic disease or very special health provisions.
And what a delicate human! My physician should train himself regularly how to help the sick so kindly and friendly without raising the least doubt or suspicion of any shortage as for medical proficiency and personal balance. Doctor’s work must be almost perfect. My physician does not like to work as much like a machine. The dehumanization technique, though logically important, is not absolutely working because my physician thinks that sharing the sick some of the pain is quite good for a guérison. My physician would experience and live inside some medical cases in a time to become quite exhausted and can’t see more cases. That is why a regular moral washout and physical and mental refreshment are very important. Not only concerned with bodily diseases, fighting infections, curing debilities, and ameliorating pains, but also and vey often sympathizing financially and engaged personally and socially.
My physician is very proud to convey a particularly beneficent message to the needy and sick people and insists to practice this job with much love and sincerity. As a mere human my physician can’t be blamed or insulted, but – on the contrary – should be honored and respected. My physician may succumb to any moral, physical or psychic concerns and devotes a whole life and resources to help fix or tame those defects or phenomena. That’s why my physician is deservedly described as mere human.
Under this delightful Italian salutation I wish to emphasize the importance of language for the physician. Indeed, language use and mastering is one of the big challenges to be a good physician provided that good and gentle contact with the patient constitutes in most cases the secret word towards cure and release. This fact is very striking when caring for a patient of different language and culture. The patient would be so surprised and impressed when the doctor utters his/her own language words in an agreeable manner dispensing the need for an interpreter. This should be a preliminary reason to achieve patient’s confidence and cooperation. Again, the patient’s description of the present complaint in a language that is felt and tasted should help the physician to resolve the case much more precisely. The wonders of good language communication are far away from being simply listed especially when pain to be relieved and suffer to be eased.
The rendezvous with the language does not stop at containing the many Latin and Greek words and terms but the physician maybe appointed to walk a long and interesting experience with learning and practicing many tongues to help maintain good communication with people and refine the health care provision.
A sweet dreamy child is fond of various amusing, challenging and curious items. From playing hide and seek through living in a cartoon to flying far with a cup of fruit glace. A mark of talent and infinite will to joy and dream. Yet, the questions would visit the little genius, who finds always simple and lovely answers; “When I grow up, I would get married and have a fridge full of food and fruits.” So, the little sees the promising lovely future. Not once seen singing like popular singers, glowing in matches like the best footballers or drowning in thinking and trial like a great scientist or a philosopher. We got a treasure of abilities waiting for love, care and refinement. Such genius will find many chances to show admiration to goodness and creativity.
What? Would I be a doctor? The word sounds me very nice. I like the person too, full of passion, wisdom and respect. I don’t know a doctor in my family but I feel like I am stolen by the word and its reflection. I like to help everybody especially the needy people and those who are sick and weak. A doctor puts on a shiny white coat, gives prescriptions and can save lives by doing surgery. I can agree generally with all this but in fact it is the word – doctor – that interests me this time, the word itself not the job. I can live with such a word that sounds in my ears and soul like a mercy of an endless spring.
The physician has preliminary physical, social, financial, moral and intellectual conditions that suit the requirements for interrogating, examining and treating patients. Besides this the physician may have the opportunity to do medical research in basic and/or clinical studies that may necessitate the engagement in a team work of other disciplines like engineering, physics, chemistry and biology. Though the work of a physician is almost a matter of continuous training and practice, yet this work is largely dependent on the way how data are managed and saved. Nice and efficient data handling should help the physician for better results with less effort, cost and time.
And now, to a brief note about the progress of medical practice that I wish to be useful:
– Leeuwenhoek makes the first microscopes (1673).
– Lavoisier discovers the conservation of mass (1774).
– Avogadro defines the mole as a unit of mass for chemical reactions (1811).
– Jenner discovers the vaccination (1796-1811).
– Robert Koch puts postulates for infectious diseases (1890).
– Rontgen discovers the X rays (1895).
– Fleming discovers the penicillin (1928).
– Watson and Crick deduce the chemical structure of the DNA (1953).
– The complete sequence of the human genome is known (2003).
Practicing medicine is a job that should be given out of both knowledge and admiration. Enjoy it!