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“Wise men say only fools rush in” – Elvis Presley

When I was in academic medicine as an assistant professor of Radiology, one of the great perks of the job was to help teach the medical students and residents that were on my service.

I was known for thinking a little outside the box (which should come as no surprise for regular readers of this website).

My specialty was simplifying somewhat complex medical concepts into a more easily digestible form.

I was great at creating Mnemonics and known for making quickly sketched drawings to explain such things as the physics of MRI or Ultrasound (all fair game in the Radiology board certification process).

One of the proudest moments during my stint in academia was when I received the Teacher Of The Year award for my efforts.

After my transition into private practice medicine (hastened by of all things Ebay), the teaching aspect of medicine had fallen by the wayside.

Sure I would get an occasional college, or even high school, student that would ask to shadow me for a day or perhaps a week, but this truly was a rarity.

The hustle and bustle of private practice also did not quite allow for the leisurely jaunts down the academic rabbit hole that were more amenable with the teaching hospital setting.

Fast forward a decade or so and I was honored when my girlfriend (now fiancee), who was about to take the Clinical Skills Step 2 of the United States Medical Licensing Exam (USMLE), asked me if I would help her prepare for it.

 

 

When I took the USMLE exams in the 90’s they did not have the Clinical Skills assessment so I was unable give her any insight based on my past experiences.

The basic premise was that each examinee was handed some relevant clinical information prior to even entering the examination room.

In the examination room the examinee was able to examine and question “the patient” who was typically an actor/actress.

The examinee would then be required to document relevant findings, give a differential diagnosis, and order appropriate workup if necessary.

This entire process was to be completed within the allotted 15 minutes.

The process was then repeated until the examinee underwent a total of 12 patient encounters.

To be honest, I thought this was a great step forward in the USMLE certification process as it actually simulated “doctoring.”

It certainly was much more relevant to a physician’s day to day practice than some of the more asinine hoops doctors have to go through such as memorizing the 8 steps of the Kreb’s Cycle (a favorite element found in Step 1 of the USMLE).

[After 17 years as a board certified radiologist I can tell you that the Kreb’s Cycle has not once come into play helping me make a diagnosis.]

I thought the best way to prepare my girlfriend for the exam was to simulate being a patient using several test examples they provided.

One of the things I noticed early on was that there seemed to be a preoccupation with the time limit.

My girlfriend seemed rushed to get to the actual physical exam and patient questioning and would only cursorily glance at the initial information provided.

This would lead to some awkward pauses as I could see her trying to think what to ask next or if there was a particular area that she needed to concentrate on for the physical exam.

 

 

After a few more awkward simulated patient encounters, I chimed in and told her that it may be in her best interest to actually take more time and analyze the provided medical details first before entering the examination room.

We went over another example together but this time I forced her to spend a few minutes contemplating the information given to her before stepping one foot into the examination room.

For each given clinical history I asked her what was running through her mind as the potential medical problem before even seeing the patient.

I told her to envision the differential diagnoses possible with such a patient presentation and what are some of the questions she should ask to help sway her one way or the other to the right diagnosis.

I then asked her if there are any things on the physical exam that might also point her in the right direction.

Lastly I asked what are appropriate labs or imaging studies that might be needed to solidify her diagnosis.

Again this was all addressed prior to even meeting the patient.

From that moment on it was sort of a medical awakening for her.

Every subsequent simulated examination went smoothly.

I truly was impressed how she seamlessly went down her question list and conducted the appropriate physical exams for a given presentation.

Gone were the awkward pauses.

In its place I saw a very confident and capable doctor who did everything appropriate to solve the current medical mystery that had unfolded before her.

My girlfriend did indeed take the exam shortly after this and of course I was curious how it went.

She admitted she got nervous with the first patient encounter and kind of jumped right into the patient room when she saw all the other examinees do the same.

However after that initial patient, my proposed method of tackling the exam seemed to have kicked in.

With every subsequent case she was indeed the last to walk into the room and meet the patient, using that initial time to formulate her plan of attack first.

I was immensely proud of her when she did pass the Clinical Skills test with flying colors.

Takeaway:

Too often we just want to dive into things without careful consideration, whether it because of some arbitrary self-inflicted time limit or just impatience.

I too have suffered from this situation.

One of my bad financial habits is that whenever I have reached a certain threshold level of money saved for investing, I get quite antsy and just want to deploy it immediately.

I try to rationalize that money sitting in an online savings account is creating cash drag on my portfolio.

However just deploying money for the sake of deploying it can lead to a similar situation as rushing into that clinical exam room ill-prepared.

Mistakes are bound to happen especially if you try and shortcut due diligence because of it.

 

 

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-Xrayvsn