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Thoughts and opinion from the wards
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We have to go to the books
A round table discussion I was in today was amusing. I felt like a child sitting down in Dr. House’s office and hearing everyone works their brain out on an exotic disease. But this is not House. This is real life doctors, discussing real patients. A young woman was referred from a smaller hospital with encephalitis. Everyone started pitching in on the differential diagnoses. Somehow the resident made a working diagnosis of meningitis, and the consultant was patiently explaining that this woman presented with a classic history of encephalitis, and differentials should be pursued for encephalitis in a young women. Herpesvirus encephalitis? A course of empiric treatment with cyclovir did not make her better. She apparently lived in a farm where they have cows and she takes care of them. Clue. Her sister, at the same time, came to her general practitioner with a tonsillitis. Clue. Last year she had been to Suriname. “They will have cats in the farm!” Clue. How was the timeline of antibiotics prescription and culture when she was still at the smaller hospital? Are the culture results reliable, or are they taken after antibiotics was started? Now the doctors know they have to go back and contact the doctors at the previous hospital and get the story down to the details. A professor remarked, “We have to go to the books for the rarer cause of encephalitis”. Another younger consultant commented, “So many clues, but we can’t put them together and figure this out yet.” The discussion did not reach any satisfying conclusion. For sure everyone has to go to the books to find the possible cause of her encephalitis; digs the travel history again; studied the MRI and lab results.
This is the first time I heard professor genuinely suggested everyone, including himself, to “go to the books” to find a likely explanation. In a lot of places, they just silently think. Then orders the resident to do this test and that. Then after more results they knowingly present their answers. This time, it feels like we are trying to figure this out together.
And I’m one amused young doctor with a new understanding about how to learn; and knowing that I will definitely go to the books and look up for more things tonight.
- Ajeng. 20 February 2011- http://dokterblog.wordpress.com
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My first mentor, and the reason why I chose him as my role model is because one night he admitted an infant with direct hyperbilirrubinemia. The differential diagnoses list was enormous. It was 1995 so internet was a luxury and not available most of the time. I was amazed to see him "locking" himself in the residents room with a pile of books. He did not leave the hospital until he wrote himself an action plan with his list of differentials. He finally get the diagnosis of a Caroli´s disease. Nowadays the process is easier with internet tools, but the action and the motivation is what matters here.
Cheers