Learning Points

This page contains some brief statements and learning points written by me. Thanks for reading.

Dr Adam Iqbal

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Clinical problem-solving begins with a presenting complaint but it should not end there.

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It’s not knowledge that makes an excellent diagnostician, but awareness. The information required to reach the diagnosis is not inside you, but inside the patient. Pay attention, observe, listen, feel. Try not to make the diagnosis before you have entered the cubicle.

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Information becomes less useful as you progress through the clinical assessment process. Above all take a history and listen. And even if at the cost of all else make the diagnosis based on this.

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Pulmonary embolism is principally a haemodynamic problem, acute asthma is principally an aerodynamic problem.

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Without a preformed hypothesis to test, the process of clinical examination is often redundant.

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The process of clinical assessment is fluid and cyclical: ‘listen’ – form hypothesis – probe – ‘listen’ – reconsider hypothesis – probe – ‘listen’ – etcetera (by ‘listen’ I simply mean ‘be attentive’ to the signs and symptoms that are elicited during history and examination) (by ‘probe’ I simply mean use a diagnostic tool, such as a question or a physical manoeuvre, to collect information).

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You don’t have to be clever to be a good doctor, you just have to be able to communicate. And communication is a two-way process.

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You should make a problem list before establishing the diagnosis, otherwise things get missed.

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In order to be a good surgeon (and I would add interventionist) you have to do one thing: make the right decision and make it fast. (not my quote, but that of a surgical consultant I worked for)

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The mark of an experienced practitioner is not in what they say but what they do not.  It takes real confidence and experience to remain silent, discard what is not valuable and emphasise only what is.  If a physician spends more time in silence, listening and not talking, or if a radiologist reports very little – this often means they are experienced.