Is it just experience? I feel like I have trouble when the staff doctors grill me on stuff I should know. When I'm actually with a patient, I often times don't ask myself why a patient is giving me a certain response and when I get done talking with the staff I'm like, "Of course! That's why I couldn't refract that patient 20/20" or what ever. Any tips on "troubleshooting" abnormal patients/ atypical cases you've never dealt with before? General rules of thumb for tricky cases?
Clinical Skills: Tips on improving...
- Thread starter WMHandCTI
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It's mostly just experience.....and even when you have lots of experience you will still have cases that stump you which in retrospect seem obvious.
My personal notes:
1) A thorough history is obviously key
2) Don't forget to pinhole
3) Remember that common things occur commonly. When a patient comes in and says "I've been getting bad headaches lately" don't jump to "brain tumor" as the diagnosis. Is it possible? Of course. But rule out the common things first. As they say, when you hear hoofbeats, don't look for zebras.
4) Understand that sometimes patients will present with symptoms that simply have no physiologic or organic basis for them and there's nothing you can do about it. There's just no good reason or explanation for what they're experiencing. Sometimes, there really IS just nothing wrong with them.
If you post a specific example of something that tripped you up, we can probably be more helpful in helping you get through it.
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remember that there is always a reason for having a patient unable to attain 20/20... whether it be corneal scars, cataracts, retinal damage, etc
try to think from anterior to posterior and think of the possible reasons for a decrease in vision...
sometimes you'll have cases that cannot be solved via slit-lamp - some examples are: amblyopia, brain damage, etc
remember that you'll get better with each additional patient you see...
I don't believe that there is any quick way to do things but if I was to point to one thing that was a godsend to me was the unending repetitiveness of practicing how to do a refraction "in my sleep". I find that many new clinicians will doubt their refraction before turning their attention to the relevance or etiology of less than 20/20 vision. If there was one thing I could tell you would be to try to get as fluent as you can with refraction so that at the end of a subjective refraction, you know that the less than 20/20 vision you are getting isn't because you did a less than stellar job of refraction but because there is actually something wrong.
I've had a few of these lately, probably four or five red eye patients this past week who:
1) Didn't have red eyes - no injection of the conj or lids or anything
2) Had vague, minor, intermittent irritation or discomfort
3) Had no apparent pathology of any kind - cornea, lid, dry eye
4) Nothing in their history that pointed to anything
Basically, it was a bunch of people who I couldn't figure out what was going on. It was frustrating. I hate having to tell people that I don't know. So far I've just gone the AT PRN route and educated them to call me if things didn't get better. Seems like it's worked so far, but man, it makes me feel stupid. I just chalk it up to your fourth point and move on.
