During the first year of our Clinical Skills class, we learned how to take a patient’s history of present illness, past medical history, family history, social history, and review of systems in addition to perform a full physical exam. This year, we are building upon those skills to perform a more realistic focused history and physical and emphasizing how to do an oral presentation to a resident or attending physician in the future in order to communicate what we have learned from speaking with and examining a patient and working on brainstorming our differential diagnosis. There are several mnemonics many medical students use to ensure that we ask about all aspects of a patient’s history of present illness, and one I constantly refer to is OLDCARTS, reminding me to ask about the:
- Onset of the illness
- Location of pain
- Duration of symptoms
- Character of the pain
- Aggravating and alleviating factors
- Radiation of pain
- Timing of the illness
- Severity of the illness.
Apparently, this systematic approach has been ingrained in me because whenever a friend casually tells me about any medical issue (and they’re not even specifically asking for advice…because frankly, my clinical knowledge is not much better than their is at this point!), I default to asking those same questions I’ve been taught to ask of my future patients.
I saw a friend in the locker room at the gym last week who, knowing I’m a big runner, asked if it was normal to get lightheaded after running on the treadmill. Without missing a beat I asked, what do you mean by lightheaded? Does it only happen when you run? When does it begin? How long does it last? Does it happen every time? Are you drinking enough water? My differential diagnosis and recommendations on what to do were already reeling through my head. I think my Clinical Skills professors would be pretty proud!
I wonder if you’re ever really able to switch out of “doctor mode” when it comes to these sort of things. But perhaps being able to critically think about real life situations, even if they’re your friends’ and family’s problems, is a sign that I’m progressing towards making the challenging shift from a book smart student to a more focused and savvy clinician.