Wednesday, October 02, 2013

How To Study Medicine (v2013)

I have gotten it all wrong all along.

Medicine can be a bottomless pit of information. (cue: UpToDate, Harrisons, Last's)

But take a step back, and with the right frame of mind it is not too difficult.

(this article supersedes what I wrote in 2010 as a medical student)

To explain a point, let me first explain how to make a cup of tea.
  1. Place water (dihydrogen monoxide) heating device (kettle) under faucet.
  2. Align nozzle of faucet in the vertical plane to ensure smooth flow of water into heating device.
  3. Turn faucet knob counter clockwise to release water.
  4. When the water has reached a level indicated by the meter on the side of the kettle, turn the faucet knob clockwise to halt the flow of water.
  5. Place the water heating device on a secure surface close to a power socket.
  6. Insert power plug into said socket.
  7. Turn on water heating device.
  8. Place bag of tea into a water containment device (mug).
  9. Wait until water boils - the device will automatically shut off when this occurs.
  10. Pour hot water from kettle into water containment device but leave 1-2cm of space to prevent spillage.
  11. Use a spoon to stir / agitate water to ensure maximum contact between tea leaves and the dihydrogen monoxide.
  12. Remove tea bag after 2 minutes to prevent release of tannins that taste bitter.
How to make a cup of tea: Boil water and pour into a mug with a tea bag. Remove tea bag in 2 minutes to prevent tea from becoming bitter.

There. Simple isnt it?

Medicine is alot like that. Reading medical resources can seem daunting, but the reality is that alot of things can be simplified and just flows naturally.

The difference between a medical student and a doctor reading medical resources is like night and day. One sees a myriad of minutae, the latter distills the important points from the literature. It's the idea, the concept, that counts.

How To Study Medicine

Answer the question: So my pt has this (presenting complaint or confirmed dx), what do i need to do next?

There. It's really that simple.

Trust your instincts. You are not reading for reading's sake like in highschool/university. You are not a robot. You are searching for answers to questions. The greatest tool to studying medicine is your humanity, the understanding of the human condition.

As a medical student you are probably at awe at the depth of knowledge of the registrars and consultants. They got to where they are by putting a lot of blood sweat and tears in to medicine and the pursuit of knowledge. True some of it is pure IQ, but most of it is the simple fact that more senior doctors have had more "WTF moments"; as in, what the f*ck do i need to do now with this pt in front of me. Clinical decision making is built up over time, from advice of seniors, literature/resource searches, and sheer experience. Each axiom being integrated over time into working memory. Intuition comes from the subconscious processes in one's working memory. Clinical reasoning is built upon the hardcore literature searches and reviews on how to manage condition X and Y.

It will come together. Give it time. Let axioms sit and brew in your head as you manage your imaginary patient. Remember, it's all about the patient. If you have a patient in front of you, the learning accelerates exponentially. It becomes "real" to you, and whatever axioms you dig up on how to manage the patient in the following hours are pure gold in terms of the pursuit of knowledge. That 15 minutes you spend reviewing a case, answering clinical decision making questions, and searching for how to treat your patient is more valuable than spending 2 hours reading textbooks.

To summarize:

1) It's all about the patient.
2) Read with the INTENT of knowing what to do if a pt is in front of you.
3) Give it time to sit and ruminate. Dont bite more than you can chew. THINK. Reflect.
4) Patients are your best teacher. Debrief. Debrief. Debrief.

In General, you'll need to know:
[  ] How to approach a condition (a way of looking at things: eg. pre/intra/post-renal failure)
[  ] What alternative diagnoses to consider
[  ] Ix/Ex findings.
[  ] How it affects a pt's wellbeing / red-flags / urgent differentials that need to be ruled out.
[  ] Outline of therapy (not drug doses). The clinical indication for choosing X over Y for therapy.


  1. Medicine is alot like that. Reading medical resources can seem daunting, but the reality is that alot of things can be simplified and just flows naturally. azithromycin chlamydia