Seriously, I didnot know whether I should be pissed off or be happy with my long case exam just now.
I am not happy because
1) I got a patient who does not know how to speak or even understand Malay or English.He is a Bangladeshi patient to be exact.Came with central abdominal pain of 1 day duration.I had to use a translator for history taking, and it was tough and time consuming.It took 1 and a half hours for everything-ie history taking, physical examination,summary,provisional and differential diagnosis,investigations and discussion.Most of the HOs and MOs in the ward were in disbelief when I got this patient for my exam.They themselves have difficulty in extracting the history from the patient.
The case was a difficult case and I was the only one in my batch to get him as patient!Anyway, I think I did allright, though it could have been better.I manage to come out with the correct final diagnosis.The diagnosis was " Subacute Intestinal Obstruction secondary to Adhesion colic" .My reall really strong point for supporting the diagnosis was " This patient have a right paramedian scar due to his previous abdominal surgery in Bangladesh.During the process of healing, there will be fibrous tissue formation which will make the gut to adhere to each other".Something like that. Initially my provisional diagnosis was "Strangulated Incisional Hernia" due to the presence of that surgical scar but however during the physical examination the cough impulse was negative.So I've decided to change my provisional diagnosis to that adhesion colic thingy.
2) We did not know when is our examination, as in the time.We always need to be ready, handphones must always be with us at all times.I received and SMS from Mr Ahmed the surgeon(my examiner) at 10.45 am while I was at the Surgical clinic.I need to be at the Surgical ward 3A in 30 minutes time for my Long case exam.I was anxious for one whole day yesterday because 7 of my friends had their long case exam already.
I was happy because:
1) I did not really clerked the patients prior to the exam.I did now even bother to know the diagnosis of the patient in the ward.This is to prevent bias in exam.We tend to be bias if we've already know the diagnosis .We tend to forget to ask other relevant symptoms which might be related to other differential diagnosis.Bias is really really really dangerous in any medical examination
Currently preparing for my Best case write up report, SWOT analysis, Reflective diary, Peer assessment, and for my Written examination.Argh!