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Friday, July 5, 2013

Lessons I Still Remember - 3

Note from Speedy

I am really pleased to see early and hopeful evidence of others taking up my request to share what they learnt from our great teachers. Zita’scontribution is most welcome. Let us hope that more will follow. As promised, here are a few more recollections. 

From the best clinical teacher I ever had, Dr Wickrema Wijenaike. I was privileged to be his SHO and he laid down a few ground rules when I started which after 40 years are still relevant to sound medical practice.

(a)    If you request an investigation, you must justify them by telling me why you asked for them and how the results would help in the diagnosis and management of the patient.

(b)   You can prescribe a drug only if you can give me why it is indicated and show me that you are aware of  the side effects of the drug and how to manage them. To memorise the dose is not important, you can always refer the Formulary.

2. From Dr. George Ratnavale, Consultant Neurophysician (preferred term for Neurologist those days in Sri Lanka), probably one of the best dressed and polished clinicians in our time, tall and elegant with a graceful walk. In one of his Ward Classes, he asked us to take a history from a young patient with a severe headache which was relieved by the application of a wet cloth soaked in Eau-de-cologne on his forehead. The young man had a Pituitary Tumour and was dismissed by earlier clinicians on the basis that a headache which responds to such a “placebo” could not have a serious underlying cause. The lesson was not to be distracted by what seems a dismissive feature in a patient but to be thorough in your evaluation and take account of the whole clinical picture.