The Fever Case: Attending Classes - Part 2

Dr. Dev (fictional name) while a MBBS student had attended few classes of Dr. AM (fictional name), a strict but fair teacher during his ward posting in the Medicine Department in AIIMS, New Delhi. When the time for end of ward posting came Dr. Dev was allotted a case of fever. Dr. Dev examined the case but could not find any abnormality on physical examination of the patient.

When his turn came, Dr. Dev presented the history of the patient. While presenting the physical examination findings, Dr. Dev presented his normal findings and added that he has not been able to find any abnormal finding in this patient.

Dr. AM was surprised and called the senior resident allotting the case during the exam. He asked the senior resident that why has he allotted a patient without any physical finding in the exam. The senior resident replied that the patient is having the physical finding of enlargement (increase in size) of both the liver and spleen organs.

Instead of castigating Dr. Dev for missing this physical finding and failing him directly, Dr. AM, perhaps taking in account Dr. Dev’s attendance in classes, asked to re-examine the patient’s abdomen and tell him the physical findings.

With his attention focused, Dr. Dev was able to feel the minimally enlarged liver and spleen which was difficult to feel at MBBS level, presented his revised findings and gave the further viva based on these clinical findings and managed to get reasonable marks in the exam.

A favorable impression is created on the teacher by the student attending the classes, which may useful in exams. A positive bias may be created in the teacher’s mind which may lead to higher marks / score in exams or may save the student in difficult or borderline situations.

Therefore attending classes may be some time life-saver to the average or the borderline students.

(Based on true incident)

— ND
© Author. All rights reserved. 


DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm. 

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See also the first article on attending classes at 'The Rabies Class'

The Rabies Class

Though it may appear contrary, the lazy but smart student makes is a point to attend classes by teachers.

There may be exceptions, but in most classes, there is lot of material to be covered in a limited time. The teacher’s task literally becomes like filling and delivering the ocean in a pot. Therefore, a good teacher separates the chaff from the wheat and delivers the most important concepts and points in the class.

This gives an indication to the student on what to give more emphasis in his self-study and at time of revision, and what to omit if there is time shortage.

For example, Dr. Dev (fictional name) attended the Microbiology class on Rabies and other diseases caused by viruses. The Rabies section of the chapter was around one and half page in the textbook.

In the class, the teacher just told three lines: Rabies is caused by a Rhabdovirus, it is a bullet shaped virus, Negri Bodies are seen in nerve cells in brain.

At the time of final revision just before the exam, Dr. Dev just read this three lines from his class-notes and omitted the entire section on Rabies from the textbook due to lack of time (lazy-lazy). In the exam, the only question asked about Rabies was whether it is caused by a bullet shaped virus or not, which obviously he answered correctly.

So, on an effort to benefit ratio criteria attending classes can turn out to be quite profitable.

(Based on true incident)

— ND
© Author. All rights reserved. 

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm. 

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The Chronic Liver Failure Lesson

Dr. BK (fictional name), when still a MBBS student, appeared for his first surgery ward posting clinical exam in 3^rd semester in AIIMS, New Delhi. In the 3^rd semester posting, it is expected that the student should know the basic clinical history taking and general physical examination.

Everyone was amazed when Dr. BK got 80% marks when the class average marks were in the range of 55 to 65%.

On enquiring it was found that Dr. BK was asked about the signs of chronic liver failure in exam, which he answered brilliantly. This one answer was enough for him to top the exam.

On further inquiry it was found that in the night before exam Dr. BK has specifically prepared the answer to the question, ‘what are the signs of chronic liver failure?’

So, how did Dr. BK knew before hand that he will be asked about the signs of chronic liver failure in exam and prepared accordingly.

Did he enter in a deal with the senior residents allotting the case to get a case of liver failure allotted to him? On enquiring it was found that the case allotted to him was not having liver failure and was randomly allotted to him?

Did he entered in some kind of deal with the examiner so that he will ask him about the signs of liver failure, no matter what the patient was suffering from and prepared accordingly? This was not the case as the examiner was quite fair and strict examiner.

Did Dr. BK consulted some psychic to tell him the question which will be asked in the exam the next day? No, nothing like this. 

So what was the answer to this mystery of preparing a specific answer in exam to get topper level marks?

On deeper investigation into the matter the mystery behind Dr. BK’s success revealed some interesting facts.

In the exam viva, when his turn came, Dr. BK presented the clinical history of the patient and answered the examiner’s question regarding it, similar to other students.

When it was the time for presenting general physical examination findings, Dr. BK also presented his findings of the patient's vital signs such as pulse rate, respiration rate, blood pressure and temperature similar to other students.

Now he came presenting the general signs of health regarding anaemia, jaundice, chest and heart, etc.

Normally, the students say, there is no pallor (for anaemia), no cyanosis (for breathing and heart failure), no raised JVP (for heart condition), no icterus (for jaundice, usually due to liver failure), etc.

Dr. BK, after saying, there is no pallor, no cyanosis, no raised JVP, no icterus, added, with a slight cockiness in his voice, “Sir, there are no signs of chronic liver failure in this patient’’.  This was expected as there was no liver illness in the patient allotted to Dr. BK.

The examiner was piqued by his confident statement, that “there are no signs of chronic liver’’. Usually in 3^rd semester, students do not comprehensively know the signs of chronic liver failure, which can literally effect from head to toe.

With an aim to take Dr. BK a peg or two down, he asked, “And, what are the signs of chronic liver failure which you looked for in this patient?”

Dr. BK, replied, “Sir, starting from head, there is no loss or discoloration of hairs, no icterus, no loss of axillary (armpit) hairs, no gynecomastia (enlargement of breast in males)”… and so on till “no white, brittle toe-nails.”

The examiner was amazed at the depth and thoroughness of his knowledge and gave him 80% marks, while most students in his batch got 55 to 65% marks only.

Dr. BK knew before hand that, in the surgery exam he will be asked about anaemia, jaundice, etc. which he studied same as other students. In addition, in the night before exam, he had specifically prepared in great detail, the signs of chronic liver failure.

Usually examiner asks the details related to the patient’s illness and condition.

Even though, the patient was not having any liver illness, while presenting the general physical finding, his cockiness and confident statement, ‘that there are no signs of chronic liver failure in this patient’ was akin to waving a red flag in front of a bull.

The examiner could not avoid cross-examining his statement, which he replied with his thoroughly prepared answer.

This technique is forcing or leading the examiner to ask you some question which you are well-prepared.

It requires you to prepare in great details and beyond your expected level of knowledge, answer to some question, you will be likely to be asked in exam.

The question should be related to some point which you are going to be asked routinely, so that you can link the question to it. In this case, all routinely say, jaundice in not present, to which he linked, signs of chronic liver failure.

Make generalized statement, for which the examiner will demand details, to see if your statement is justified.

While making this generalized statement, there should be confidence and even a bit of cockiness in your voice and body language, so that the examiner take it as a challenge and ask you to justify your statement. Look the examiner in the eye when making your generalized statement.

Don’t give details until specifically asked for. For e.g. Dr. BK, could have told the details of signs of chronic liver failure without being asked, but he reserved it for next question.

So, with a little before-hand preparation, you will be able to force the examiner to ask you favourable questions, creating a good impression for you.

But beware, overconfidence and cockiness in general should be avoided in exams and interviews, to avoid antagonizing (angering) the examiner. This is a high risk to high reward game, and not all will be able to pull it off brilliantly.

(Based on true incident)
— ND
© Author. All rights reserved. 

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm. 
 
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The Stone Therapy

A young man, driver was profession, from rural area, got acute severe pain in abdomen and went to consult a doctor.

The young driver did not reach his home in night. His family members became worried. With increasing ticking of the clock their worry increased. In the end they decided to search for the young man.

Finally, they found him lying semi-conscious below a tree in their farm. A small puddle of urine and many empty beer bottles were surrounding him. Arousing him with great difficulty they asked him the meaning of this.

The young man told them that he first went to a doctor. He was investigated and found to be suffering from stone in ureter.

For Non-Medicos: Ureters are a tube like organ connecting the kidneys to the urinary bladder. Urine is continuously produced in kidneys lying one on each side in abdomen. The urine gets collected via the ureters and stored in urinary bladder (a bag like organ) lying in the midline in lowermost part of the abdomen. 

Stones if present in kidney do not cause much pain as there is plenty of space for the stone to move around. When the stone, with urine come in the ureter they cause severe colicky pain as the ureter is very narrow. Many stones, if small enough will pass out the body in urine.

The doctor prescribed him some medicines along with advice to drink plenty of fluids by mouth so as to produce a large amount of urinary flow.

On the way back to the village, the young man met one of his friends, who gave him the popular advice to drink beer as this help in passing out the stone (expulsion).

Please Note: This fallacious advice is based on the diuretic (urine producing) effect of the beer and the fact that young men prefer to drink it in large quantity as compared to plain water. Due to ill-effects of alcohol, it is not recommended to drink beer to remove stones.

The young man, who was in great pain, found the advice of his friend great and decided to follow it.

He thought that drinking beer will lead to immediate passage of the stone in urine.

So, the young man bought few crates of beer bottles, sat under a tree in their farm and started to drink beer one after another, passing urine in between and checking to see if the stone came out or not, and so on, till he had consumed more than 20 bottles of beer since afternoon.

Unfortunately, still the stone did not come out.

So, be careful in following folk-lore advice, and don’t take their meaning literally.

When advising someone, be careful to make sure that he understands it correctly.

(Based on true incident)
— NKD
© Author. All rights reserved. 
DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 
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