当前在线人数14775
首页 - 博客首页 - 美国医学教育博客 - 文章阅读 [博客首页] [首页]
Present yourself with a clinical case
作者:USMedEdu
发表时间:2007-10-18
更新时间:2007-10-19
浏览:1405次
评论:0篇
地址:68.
::: 栏目 :::
现代医学vs“中医”
社会、艺术与医学
住院/FELLOW单位
中外医学网站精选
国内外医学交流信息
生物医学人物
力刀美加医学教育专
临床见习/实习/义工
医学生理学诺贝尔奖
医生助理(PA)职业
医学书籍照片及图谱
社会与医学瞬间定格
医学典故/医史杂谈
USMLE复习和考试
申请和面试住院医生
住院医生生活和工作
FELLOWSHIP
医生就业、工作及生
医学科普及问题解答
美加医学院申请/MCA
中美医学临床教育比
医学新进展及新闻
社会医学伦理

By Jimmyzhang

不少单位面试的时候会要求你给一个有趣的病例,我在临床时间比较长,这是我的强项,所以即使没有要求我谈病例的地方,我也会想办法拿出一些有趣的病例来谈。比如,问到 What is your strength and weakness?的时候,你干巴巴的说几个词出来,显然是没有影响力的。这时候,我就会说: I am enthusiastic, I pay attention to details, bla, bla, bla……然后,我马上就会开始讲故事来说明这些优点和缺点。另外,如果面试时间足够长(特别是病理面试),你肯定得准备很多有趣的话题来谈。我面试前分别为内科和病理准备了6个病例故事,写出来,并且打印出来随身带着去参加面试,根据需要随时都可以很流畅地讲出来,也根据面试时间随时调整讲故事的长短。
下面是我准备的故事中的一个,作为例子,贡献出来让大家体会一下如何才能把病例讲得有特色,不仅仅表现你的临床知识,更要通过这些亲身经历的例子,说明你是一个杰出的大夫,或者能够成为一个杰出的大夫。这个故事贴出来给大家参考,但是你去面试的时候千万不要抄袭我这个故事,看这帖子的最后估计得有好几百人,你要是抄袭我这个故事,碰上两个人面试同一个地方讲一个雷同的故事,你就自认倒霉吧。
--------------
I worked as a physician and hematologist in China for many years. A lot of interesting cases were memorable and added to my clinical experiences. But the case I remembered most clearly is this 23 year old male I encountered almost 20 years ago, when I was a second year resident rotating in the division of pulmonary disease.
The patient was a college student with high fever and hydrothorax. He brought with him an PA chest X-ray film from his college clinic which clearly showed pleural effusion up to the third intercostal level on the left side. We suspected it was caused by tuberculosis, which was the most common cause of hydrothorax in China at that time. After a brief history and PE, my supervising attending told me to do thoracocentesis because we realized that it would not be easy to control his high fever and TB infection without first reducing the massive amount of pleural effusion.
Before the procedure, I thought it was important for me to do a careful PE myself. To my surprise, I found that I could hear weak breath sound over the back of left chest, and the percussion sound over that region was not as dull as I would expect from a hydrothorax patient. I reported my PE findings to the attending and suggested a lateral chest X-ray in our own hospital. The attending was not very convinced. He said it was not necessary to waste 2 hours on the x-ray while we were quite sure of the hydrothorax, and the standard procedure was to drain at the tenth intercostal space over the back. I told him that I suspected that the effusion was restricted to the front of the pleural space. If we do needle drainage over the back, we may hurt the remaining lung and make a pneumothorax. I insisted to get a lateral chest x-ray before we could do the procedure. Finally, the attending went to have a careful PE over the chest and then agreed to send the patient to radiology. One hour later, we got the chest x-ray film back. Sure enough, the pleural effusion was restricted to the front half of the chest. I chose an entry point based on the chest x-ray and drained about 1 liter of exudates. Pleural biopsy confirmed TB infection. The patient was put on anti-TB protocol and discharged in one week after his fever was controlled.
My memory of the case lasts to this day. Because I learnt a lesson from this case that, as a physician, we should find an explanation for any unusual clinical findings. A proper management may just depend on those negligible findings. Also, I am very sure that the attending remembered this case for a long time. After I got my PhD degree and went back to my university hospital, the attending was already the associate director of the Department of Medicine. When I applied for a promotion to associate professor of medicine, he gave me a very strong recommendation in the university’s academic committee. He said that I had an exceptional talent and strong potential to become an excellent physician.
------
故事讲完后,大多数面试我的人都会相信我的临床能力还是不错的。有一个PD问了我这么一个问题:
What do you think is the reason caused the pleural effusion restricted to the front?

[上一篇] [下一篇] [发表评论] [写信问候] [收藏] [举报] 
 
暂无评论
 
用户名: 密码:
发表评论
评论:
[返回顶部] [刷新]  [给USMedEdu写信]  [美国医学教育博客首页] [博客首页] [BBS 未名空间站]
 
Site Map - Contact Us - Terms and Conditions - Privacy Policy

版权所有BBS 未名空间站(mitbbs.com) since 1996