Category Archives: Advice

“Get a hat pin” A consultant I had for rheumatology carried a hat pin around with him. I asked him why, and he said, “It’s useful for loads of things, testing blind spots, sensation, colour vision, instruction following, small object perception… and it holds your hat on”  Basically this point is to say you shouldContinue reading “Hat pin”

Nerves crossing a joint supply: Muscle Skin Joint This is a reminder that whenever doing any examination of a joint, you must consider any nerves that are crossing that joint, and what they supply. Especially important for situations such as a dislocated shoulder, where you must test sensation over the deltoid to see if theContinue reading “Muscle, Skin, Joint”

What else is there? Rather than a morose outlook on life itself, this nugget was a great little for when you think you have worked out what the problem is. What other problems or lesions are there? Congenital anomalies especially often travel in pairs or groups. Trauma patients may have multiple fractures that aren’t immediatelyContinue reading “What else?”

  When clerking a new patient, taking the history and performing an examination, it is very tempting to try and work out what pattern the patient fits into best – making your own diagnosis is the whole point of doing medicine, and of course, is good practice. However this risks a tunnel-visioned approach that canContinue reading “Say what you see”

Immerse yourself. The best advice I ever had at medical school – spend as much time as you can just being around patients on the wards. Books have lots of wonderful information in them, but they’re a very ineffective way of learning. as the material is abstract with no experiential hooks for your brain to fishContinue reading “Go for a swim”

Your clinical opinion is always more reliable than a test. More precisely, the clinical opinion of your consultant. A low CRP does not mean no infection. A raised D-dimer does not mean a definite pulmonary embolism. A result that doesn’t fit with your clinical suspicion should make you question your suspicion, but should not overrideContinue reading “Use your nut”

You as the expert clinician with multiple years of dedicated training under your belt may be incredibly confident that you know what the patient needs, but they know what they want. Usually what your patient wants is rapid, painless recovery, which you usually aren’t able to give them, however just being able to express it to someoneContinue reading “Ask your patient what they want”

Medicine is an evolving, mobile and fluctuant creature. It is never finished, and neither is your assessment of your patient. What it is not: See patient, diagnose, start treatment What it is: See patient, form likely differential, begin most useful treatment, reassess, tweak and alter treatment to optimise response, reassess, reassess, reassess! The old ABCDEContinue reading “Reassess, reassess, reassess”

This one is a little less silly than it sounds. Medicine is getting all the more complex as technology advances and we get better at testing for different conditions. This means a lot of people pay excessive attention to the numbers, and not to their patient, often forgetting the basic principles especially in an emergencyContinue reading “Stop the bleeding”