Post 84 The student who was not as clever as he thought he was!

 

Jim was taking the Final Medical School Examination.    Pass and he became a doctor; fail and he would remain a student and have to sit the exam all over again in six months time. The most important part of the exam was

the bedside assessment of clinical skills.   Each candidate was allowed 30 minutes alone with a patient before being required to present the case to an examiner.  Jim knew of course that the patient  would have been instructed not to reveal their diagnosis.    However, believing himself to be a rather smart young man, he decided that when introducing himself to the patient, he would open in a manner which might trick them into revealing all.

Instead of opening with the usual ‘Now tell me Sir, what symptoms do you have?’  he would distract the patient by engaging them in some inconsequential chatter, then suddenly throw in ‘Now we’d better get started, so tell me what’s the matter with you?

It worked.

‘I’ve got dilation of my ventricles,’ the patient replied.

Jim wasn’t surprised that the patient was  so easily deceived. He was elderly and pleasantly befuddled. Furthermore as Jim spoke with him, he confessed to almost all the symptoms that Jim suggested; fatigue, pains in the

chest when walking, breathlessness when laying flat in bed at night and swelling of his ankles which was worse in the evening.

Well satisfied with his progress, Jim then spent twenty minutes undertaking a detailed cardiac examination, then sat back and prepared himself for the grilling on the causes and complications of a weakened ventricular wall that would inevitably follow when the  examiner arrived.

The examiner was a physician from a neighbouring hospital whom Jim had not previously met. He came straight out and asked for Jim’s diagnosis.

‘Dilatation of the ventricles, Sir,’ Jim said in his most confident voice.

The examiner was very impressed. ‘Very,very, well done young man,’ he said. ‘You’re the first candidate this morning to make the correct diagnosis. What made you come to that conclusion?’

 ‘Well, Sir’, Jim replied, ‘it’s obvious that he’s in heart failure. I’ve examined his heart very carefully and found that .......’

At this point, the examiner interrupted Jim, 'so the ventricles of his heart are dilated as well as the ventricles in his brain, are they? That really is most unusual.'

                                                                                           

’

And so it was that Jim remained a medical student for a further six months whilst all his friends qualified as doctors and took up their first medical jobs!