LACK OF CLINICAL SKILLS – 'HYPOSKILLIA'

Abstract

As house officers, we were supposed to write a history-based diagnosis, beforeproceeding with clinical observations. After sometime the in charge of the unitdrew our attention to the fact that in more than ninety percent of cases the historybaseddiagnosis remained the final diagnosis. This was an earnest effort on thepart of our seniors to teach us the importance of history. This was like a practicaldemonstration of Osler's dictum, “Listen to the patient, he is giving thediagnosis”. In yesteryears, trainee doctors were tutored how to elicit and then 1interpret clinical signs. Heated debates used to take place on the loudness andsplitting of heart sounds and quality and radiation of murmurs. House staff wouldauscultate and invite their friends from other wards to listen to a 'rare' auscultatorycomplex. Before the era of echocardiography the only tools available were ECGand Chest XRay to help establish a diagnosis. We had to scratch our heads andput two and two together to arrive at a diagnosis. In our unit, all house staff had towrite daily progress notes under four heading SOAP – subjective complaints,objective observations, assessment and plan. The most deficient parts used tobe objective findings and assessment and hence a flawed plan as most housestaff would not pay heed to the clinical findings.In current times, a decent chronological succucinit history.

What we need are teachers, who are God-fearing and compassionate equipped with common sense, candor and devotion.Weneed teachers, who do not consider medical practice as a business but a true calling. Faculty, who have the time and moreimportantly commitment to listen and talk to patients. Medical teachers who truly believe in taking a good history, conducting allencompassing examination and order selected relevant tests. Doctors, who reflect on a regular basis and strive to improve upontheir medical practice. Tutors, who take pride in their progeny they had the privilege to teach and groom. The dream will come 2true when the doctors of tomorrow imbibe the 'Oslerian' spirit and work hard to achieve the very core of humanism andprofessionalism. 1,3