Today, during the 20th day of May 2003, we had our very first real experience with a patient. In our university, 3rd year medical students are given ward work, where they are to interview patients in the hospital. We need to gain information on the patient's illness, his/her history, symptoms and signs and of course we had to physically examine the patient. From here, and without any lab results to aid us, we should be able to come up with a working diagnosis. This diagnosis we have to defend to our preceptor. Along with this, we also have to come up with differential diagnoses (which are other diseases that can be considered in the patient's case), a management plan, and so forth. It all sounds simple, but let me assure you it's not. We had a whole year of preparation just for this. During the 2nd year, we were taught all the techniques to be used during the interview and the physical examination involving the different organ systems. That time, we had simulated patients (who were clerks) we had to interview and perform the PE skills that were taught us. With all this back-up, you would think we would be able to confidently face the patient and do everything without hesitations. But no, we were all like lost ducks in there, not really knowing how to start. I never imagined how hard it would be to ask the right questions which would somehow point us to the right direction. For example, the patient comes to the hospital with cough and fever (which was our case). We would assume that the respiratory system was the organ system involved (duh). But where do we go from there? there are like, a thousand diseases one can choose from. So we asked when the symptoms started, what prompted his admission, what other symptoms were she experiencing and so forth. After half an hour of hedging, and trying to think of more questions to ask, and coming up with nothing, we decided to compile the information we gained. They were still so pitifully few! Now, we asked the clerk what the diagnosis was (so we come fore-armed). She said it was pleural effusion secondary to pulmonary TB. Simply put, the patient had fluid in her lungs due to tuberculosis. Ok, so we were like, how can we prove that diagnosis??? First of all, we had to establish the patient was suffering from tuberculosis. Now it is common knowledge that a blood-streaked sputum is the most obvious sign that the patient experiences. But in our case, the patient's sputum didn't have any blood in it. Cough was too general a symptom to be used as the sole basis for the diagnosis. So we try to come up with others. But the patient says there were no other symptoms aside from the cough and fever. Besides which, our physical exam (PE) findings were normal! So you can just imagine the state our minds were in by the time we were finished. It would've been worth it if we managed to have something tangible to hold on to, a sort of proof or whatever. But no� we would most probably be doing major guesswork! Oh well, there's the usual first time excuse I suppose. Our lecturer said we can be excused for having lousy work because it's our "first time" (thank God). I just hope our preceptor is in a similar frame of mind when she asks us questions we can't answer.

So what did I learn from all this? It would be a very long time before I am ever ready to handle a patient. It's weird you know, being clueless after interviewing a patient. We learned a lot, theoretically, but we were really wanting in terms of clinical exposure. We can't come up with answers right away like doctors do when patients consult them. We still have to look through our textbooks in hopes of finding the answers. Hopefully, we can improve with time. I mean, everyone does� even the most incompetent ones. What I'm hoping for is that I'll rise above mediocrity and proclaim triumph over the hardships med school foisted upon my very capable shoulders. Oh, and I'm hoping I can learn the art of bedside manner (yes, it is an art! Putting patients at ease so they wouldn't be too irritable at being poked and probed).