Clinical Pearls

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

Dr Adam Iqbal

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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 we must take a history, we must listen. And even if at the cost of all else we should make the diagnosis based on this.

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If the best fighter in the world stepped out of the ring for a year, would he still be able to defend his title? Could a prize-fighter defeat his opponent without making contact? What about the consultant that stops taking histories from and examining their patients? Gaining seniority does not endow one with “X-ray vision” or telepathic traits. Clinical diagnosis requires the application of skill, and doing this consistently requires discipline and sheer hard work. Use it or lose it.

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

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Without a preformed hypothesis to test, the process of clinical examination is largely 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 (or interventionist) you have to do one thing: make the right decision and make it fast.

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“I am wrong” is the mantra of a master.