thon glaikit laddie amang the mons isna daft efter a'

2 weeks into the bridging course in University of Dundee Medical School, can't say we've really learned much haha. Most are just 1.5 hour lectures on the overview on the different specialties - Cardiology, Orthopaedics, O&G, and the like.

And of course there's also the much boredom-inducing communication skills class. Which is actually an English class in disguise. We learned how to restructure questions. And 'British' colloquial slang words mean, like awesome, loo, wee, take a hike, pissed off, bimbo, fag. Yawns. Imagine 2 hours, twice a week on that. Swear we almost asked for a refund. Haha.

Anyway that wasn't the thing i wanted to blog about here. Well, earlier yesterday, we had a clinical skills class on history taking. 3 SPs, 3 cases. Here's what one of the doctors told us about her view.

The way we take the history of the patient, is bombarding the patient with all sorts of questions, and then sifting through the HUGE load of answers trying to figure out what is wrong.

The way they take the history of the patient, is trying to figure out what is wrong while asking the questions. Sifting through the patient's answers, while asking relevant questions to rule in/out the differential diagnoses they thought of. Sort of making arguments for or against the diagnoses in their mind.

So how did they go about taking history?

Look at the presenting complaint in three ways:
1. Anatomy
2. Systems
3. Disease Mechanism

Let's say the patient has right upper quadrant pain in the abdomen. Looking at the anatomy, it might be the liver, gallbladder, lung, kidney, colon.

A patient with bilateral ankle swelling, looking at systems, it might be CVS or Renal. By disease mechanism, you might want to think what can cause the swelling? Proteinuria?

Another helpful tip is how to come up with differential diagnosis. Remember:

VINDICATE
Vascular
Infection/Inflammatory
Neoplasm
Drugs/Degenerative
Idiopathic
Congenital
Autoimmune
Trauma
Endocrine/Environment

Using this mnemonic, the causes of the symptoms can be easily figured out. For example, glomerulopathy. Infection, drugs, autoimmune, endocrine?

Hope this helps in taking histories. Happy talking to patients! (:

ps - the title is in Dundonian, the local Dundee slang. haha have fun figuring it out :P