As a second year medical student, the course of the foundation of clinical medicine was remarkably important to be taught. Clinical medicine is the art of dealing with patients and preventing an occurrence of disease. Medicine is a sophisticated occupation that is divided into multiple roots such as hematology, hepatology, cardiology, endocrinology, and gastroenterology. The core of all of these divisions is clinical medicine. It is the source of communication between the physician and the patient. This is a critical subject that all future doctors must be aware of, in order to befit as a professional, confident, passionate doctor. In Mohammad Bin Rashid University and Health Sciences, the foundation of clinical medicine was tutored by successful doctors that gave us the opportunity to learn diverse skills in history taking and comprehensive physical examination. The core of practicing medicine is patient-centered care, we were educated that patient comfort is critical of importance, we must respect their beliefs and religions, we must take into consideration their values and socioeconomic status, we must educate them about their condition and share all information, we must never underestimate their emotions and knowledge, we must try our best to gain their faith and trust. In the first months of this subject, we learned how to take a full history and later we focused on physical examination.
Foundations of clinical medicine is a step that takes me near my dream of becoming a professional doctor. In this course, the objectives were driven by informative lectures, videos that showed us different procedures, interactive lessons and moral talks, simulation center where we actually performed on patients. Physical examination was the main outcome of this course, where we spent most of our time in the simulation center learning how to achieve a full physical checkup. In the first simulation class on physical examination, I felt uncomfortable and confused, but after several classes, I was able to overcome my anxiety and disturbance by trying to carry on the procedure by my own with the help of the boost that doctors gave us. The classes that were held in the simulation center were the most enjoyable experience where you interact with a patient in real life.
We were taught how to physically examine for a general check-up which is the main method for clinical practitioners. Before starting this process, several steps must be done, we start with introducing ourselves as second year medical students, identifying our identity to the patient is an important step that assures confidentiality and trust, we must achieve professionalism and prematurity, second step is adjusting your environment so the patient and you are feeling comfortable, adjust the bed position and height, maintain good lightning that is not too bright or too dim, thirdly, we must be able to access all basic equipment needed such as ophthalmoscope, thermometer, flashlight, tongue depressor, ruler, safety pin, test tube, watch, sphygmomanometer, stethoscope, reflex hammer, tuning fork, cotton swab, gloves, specula, fourth step is ensuring patients privacy and comfortability, this is done by closing and masking the door, and by asking for their consent to get only the examined part of their body exposed and applying a drape on the unexposed area, and keeping the patient up to date about the process, this is the most crucial step which is hand hygiene and clean equipment, skipping this step may result in hospital acquired infections, we examine the patient from head to toe to ensure patients comfortability by minimal movement, we must always be on the right side of the patient, examination is done while patient is at bedrest. After achieving all of these pre-examination steps, we can start with a complete physical examination.
In the simulation center, we had the ability to implement the knowledge obtained in class on a real simulated patient. In every simulation class, the instructor demonstrated the procedure, and then a volunteer must carry the process again. When you first enter the room, you must introduce yourself to the patient, sanitize your hands, then you start with taking a comprehensive history. Before starting physical examination, you must ensure patients safety and comfortability by covering the door. This procedure is mainly focused on the four cardinal techniques; inspection, palpation, percussion, auscultation. Inspection is the observations that you see with your eyes such as abnormal behavior of the skin, palpation means applying pressure using your palmar fingers to identify any pain or elevation, percussion is tapping of fingers to determine the presence of fluid, auscultation using your stethoscope to hear sounds. We start with head and neck examination, we check the eye conjunctiva and sclera for jaundice and pallor, then ears to check for any swelling or redness, followed by the mouth and tongue for cyanosis or enlarged tonsils, fingers for signs of clubbing or anemia and hands for radial pulse, and then we check for jugular venous pulse. After determining these features, we set the bed on 45 degrees to examine his chest, we expose only his chest region, inspection of the chest to check for any scars or lesions, followed up chest expansion, percussion then auscultation of the apex beat, this is done anteriorly and posteriorly. We inspect the abdomen, superficial and deep palpation for organ enlargement and tenderness, percussion, auscultating. Moving to the legs, you press to identify any pedal edema. In a different session, they taught us how to interpret and measure vital signs that include respiratory rate, temperature, blood pressure, heart rate. The normal respiration rate is from 12 to 20, you get this number by counting the breath or auscultating the trachea. You check the temperature by ear thermometer and normal ranges from 36.5 to 37.5. After that we measure systolic (110-140) and diastolic (70-90) blood pressure using sphygmomanometer. Heart rate is measured by gently pressing on the radial artery on your wrist and normal ranges from 60 to 100.
All in all, foundations of clinical medicine helped us as medical students to view ourselves in the future as professionals that are able to cope with patients under any circumstance and achieve patient-centered care. I learned how to take a full physical examination, and taking into consideration the patient’s comfortability and privacy, and building rapport. Finally demonstrating an effective, knowledgeable, desired physical examination for the benefit of the patient is what the UAE healthcare system is trying to achieve. This opportunity of taking clinical practice courses early in medical school will improve the world’s healthcare system by graduating mindful professional doctors.