A lot of the lecturers/KKM specialists have lamented a lot about it, I have listened to 3rd degree accounts from other students, and my own anecdotal experience has confirmed it: many of the juniors do not know how to clerk patients, or at least do not know how to do it efficiently. The most basic skill of a doctor is the art of clerking, which is more important than the art of diagnosis. When you make a wrong diagnosis, colleagues and seniors can correct you based on what you got from the patient. But you can't correct if the clerking is not complete.
Regardless of whose fault it is...
Let big brother step in to help (no Barney references please). This information may be useful for juniors, or even batchmates, and other medical students from other medical schools. Okay, which would only be comprised mainly of my 2 cousins. This is not a shortcut to clerking in itself, but is a shortcut guide which is holistic in its approach to getting a patient's history. This is different from the art of diagnosis, which requires an amalgam of history, physical examination and investigations.
I derived this clerking system during third year, based on my experiences presenting cases to Dr Alik during O&G. This was because there was an incident in which none of the housemen reviewed one of the patients in the acute cubicle; I was the only one who knew, and thus had to present to him. He described the principles in which he wanted the history to be presented to a clinician. This was further augmented a year later when Dr Zamzuri (sports surgeon, KKM) described what he teaches as the 5 C's. He remembers it as "complaint, course, cause, complication, current status." I remember it as "what, how, why, what happened, now what." Pick your choice.
"What" - This is the chief complaint.
"How" - This is the "HOPI" as most know it. Your aim is to "describe the illness".
"Why" - This refers to the cause of disease. Causative factors and risk factors are described here, regardless if it's a medical/family/social/whatever history issue.
"What happened" - This refers to the complications, and management history by the medical team.
"Now what" - What is the current status? Basically, "how are the symptoms now?"
With that, you've covered 80% of what you need for diagnosis. Others may be picked up during your systemic review, or other aspects history, which you initially thought was irrelevant.
You need a shortcut guide to clerking, as when you work, you don't always have the time to write. You'll have to clerk history in your head. And you have limited time to clerk; 1 hour of clerking is for medical students, not medical personnel. With this guide, you'll be someone who can safely clerk patients and get the most required history in the first round of clerking most of the time.
Oh and another thing: for most cases, you only need 20 minutes to clerk a patient's history, and another 20 to examine the patient for long cases. The other 20 is to gather your thoughts and fill up whatever gaps there are. If it's a simple case, there really is no excuse to not get it done within that time period.
I may be someone who's unorthodox in his approach to stuff, and certainly not the smartest of students, but I'm sure that some of you can take heed of what I've taught here. I've no time to spend teaching juniors like a lecturer with my personal gym commitments and so on (unless if you're willing to wait for me for which I'll spend my time hehe), so this is a pretty good alternative to at least pay my dues as a senior. Maybe I'll talk later about my approach to diagnosis.
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