Clinical methods is something very basic. They used to expect expertise from us in that area in the junior clinical term as undergraduate students. I never thought the standards had changed. Well, change is the essence of life. They showed me it was high time I learned that.
Obliteration of the liver dullness is one test that is performed during laparoscopy to confirm that an adequate volume of carbon dioxide has been filled in the peritoneal cavity. I was assisting my house officer perform a laparoscopy. When the time came to do this test, she stopped.
"Percuss for liver dullness" I advised.
She hesitated a bit, and proceeded to percuss in the left hypochondrium. I was stunned. I had heard that women are prone to confuse between right and left. Perhaps this was a case that proved it.
"Show me your right hand" I said. She did that correctly. So the theory I had heard was wrong, at least in this case.
"Are you left handed?" I asked. I think it was an attempt at asking a sarcastic question, though I knew it was a bad attempt even as I asked it. Her right or left handedness had nothing to do with the location of the patient's liver.
"Do you think the patient has situs inversus?" I asked. She was as confused as ever. "The liver is on the right side" I finally said. Then she proceeded to percuss on the right side.
The next week I was in for another surprise. I was assisting another resident doctor perform a laparoscopy. When the time came to percuss for liver dullness, she started percussing in the right midclavicular line at the level of the umbilicus. I was aghast.
"How did they give you a case of massive hepatomegaly to perform a laparoscopy on?" I asked in mock surprise. I knew the patient had no hepatomegaly, but I had to be sarcastic. The best candidates came to us as postgraduate students, and this was shocking to me. "Is that where you percuss for liver dullness?"
"No sir" she said, "we percuss in the right hypochondrium."
"That is still an enlarged liver" I said. "Have you sold off your clinical medicine books?" She kept quiet. She probably had sold her books. "Read clinical methods today" I said. Then I percussed in the 5th right intercostal space, confirmed that the liver dullness was gone, and allowed to proceed with laparoscopy.
I wonder if the current teaching teaching of clinical methods is too casual, or current learning by the students is too casual, or both are too casual.
Obliteration of the liver dullness is one test that is performed during laparoscopy to confirm that an adequate volume of carbon dioxide has been filled in the peritoneal cavity. I was assisting my house officer perform a laparoscopy. When the time came to do this test, she stopped.
"Percuss for liver dullness" I advised.
She hesitated a bit, and proceeded to percuss in the left hypochondrium. I was stunned. I had heard that women are prone to confuse between right and left. Perhaps this was a case that proved it.
"Show me your right hand" I said. She did that correctly. So the theory I had heard was wrong, at least in this case.
"Are you left handed?" I asked. I think it was an attempt at asking a sarcastic question, though I knew it was a bad attempt even as I asked it. Her right or left handedness had nothing to do with the location of the patient's liver.
"Do you think the patient has situs inversus?" I asked. She was as confused as ever. "The liver is on the right side" I finally said. Then she proceeded to percuss on the right side.
The next week I was in for another surprise. I was assisting another resident doctor perform a laparoscopy. When the time came to percuss for liver dullness, she started percussing in the right midclavicular line at the level of the umbilicus. I was aghast.
"How did they give you a case of massive hepatomegaly to perform a laparoscopy on?" I asked in mock surprise. I knew the patient had no hepatomegaly, but I had to be sarcastic. The best candidates came to us as postgraduate students, and this was shocking to me. "Is that where you percuss for liver dullness?"
"No sir" she said, "we percuss in the right hypochondrium."
"That is still an enlarged liver" I said. "Have you sold off your clinical medicine books?" She kept quiet. She probably had sold her books. "Read clinical methods today" I said. Then I percussed in the 5th right intercostal space, confirmed that the liver dullness was gone, and allowed to proceed with laparoscopy.
I wonder if the current teaching teaching of clinical methods is too casual, or current learning by the students is too casual, or both are too casual.
