A dedication to acquiring new knowledge can sometimes be humbling, and sometimes it can be downright embarrassing
A dedication to acquiring new knowledge can sometimes be humbling, and sometimes it can be downright embarrassing
My university’s motto is Ancora imparo, which translates as “I am still learning”.
It implies that learning is a lifelong enterprise not limited to ongoing professional development on leaving university, but applying equally to learning new and diverse skills across a range of endeavours, be they sport, music, art or
any other field.
While the motto quite rightly focuses on the learner, it is silent on the sources of learning, one’s learning preferences and the nature and qualities of the teacher.
As a lifelong learner, and long-time teacher, like many of my GP colleagues I value the opportunity to use a variety of sources for acquiring knowledge and skills. I read journals, go online, attend conferences and workshops, participate
in webinars, talk to experienced colleagues and read and discuss reports from specialists.
To construct meaning from learning I need to contextualise new knowledge in relation to patient care. My most powerful and useful learning experiences have, therefore, centred on patient problems that I have tried to solve or to resolve.
For many years I have had the privilege of teaching medical students in my practice. I have always thought that teaching teaches.
Medical students bring newly acquired biomedical knowledge to their general practice encounters. They have added to my sources of learning, however there have been occasions when this learning experience has been humbling, at best, and embarrassing, at worst.
Florence was a 74-year-old widow who had attended our clinic for a number of years. I had looked after her for at least 10 of these years. She seemed in good health despite being treated for hypertension and type 2 diabetes controlled on diet alone.
She had a long history of intermittent neck pain and headache associated with restricted neck movement and X-ray evidence of advanced cervical spondylosis.
I attributed her headaches to the degenerative disease in her cervical spine. One one occasion she informed me that her father had suffered from Paget’s disease and wondered whether she may have inherited this, resulting in headaches. I dismissed this, politely informing her that as far as I knew there was no genetic basis to Paget’s disease.
Some months later I had medical student in the clinic during one of Florence’s visits and as was my normal practice I asked the student to take a history and in this case also examine Florence’s head and neck. The student soon reported back that she felt that Florence had florid Paget’s disease of the skull, supporting her diagnosis by alerting me to the size and shape of Florence’s head, the fact that she could no longer wear her cherished hats… and, of course, the headache.
An urgent skull X-ray confirmed the student’s diagnosis. Naturally, I heaped praise on the student, apologised to Florence and referred her to an appropriate specialist. Guilt-ridden and ashamed, I was grateful that Florence continued to attend our clinic.
So what did I learn from this encounter? Many things about myself and my interaction with patients. I needed to listen carefully about the patient’s concerns and ensure that I addressed them and didn’t dismiss them.
I realised that when it comes to endocrine conditions, where changes in appearance may be subtle, familiarity may breed misdiagnosis, and it is easier for a clever colleague with an open, unbiased approach, in this case a medical student, to make a diagnosis than it may be for a seasoned campaigner like me, who sees the patient on a regular basis and is oblivious to the subtle changes in the patient’s appearance.
Some time later I had an encounter with a young mother, Becky, and her four-month-old male infant, Jamie. There was a strong family history of atopy, including eczema. Jamie had a rash typical of eczema which Becky had been treating with moisturisers, without much response. On a previous visit I had suggested low-dose hydrocortisone ointment and wet dressings.
While this resulted in some improvement, it was clear that the problem was far from resolution. The medical student examined the baby and asked me if I had recommended bleach treatment… two teaspoons in the bath each day.
“Bleach!” I exclaimed, as I looked at the surprise on Becky’s face. “Yes,” the student replied, “it kills dermal staphylococcus which may exacerbate eczema. It is in the Royal Children’s Hospital guidelines for treating eczema.”
Becky and Jamie returned a week later. Jamie’s skin had never looked better.
The value of having a medical student in practice was once again reinforced as was my belief that teaching teaches.
Leon Piterman is Professor of General Practice at Monash University and has been in clinical practice for almost 40 years
Do you have similar professional experiences you would like to share? Please email: grant@medicalrepublic.com.au
