GM Assignment July

 GENERAL MEDICINE

BIMONTHLY ASSIGNMENT for July

 ~ Rishitha, 3rd Sem


I have been given the following Assignment in an attempt to read, comprehend, analyze, reflect upon and discuss captured patient centered data.


QUESTION 1 (Peer to Peer Review)

I have reviewed roll no.37’s blog. 

Overall, there had been a misperception of the first question and hence the answer presentation was differently done by the peer. I have reviewed it accordingly.


1. NEUROLOGY

Quantitative assessment : 7/10

Qualitative assessment : 

  • Good pictorial representation for easy understanding.
  • Must have used bullet points to make it less clumpsier.
  • The answer must have been more presentable.


    2. GIT- 1

    Quantitative Assessment : 9/10

    Qualitative Assessment :
    • The case summary has been well explained.
    • Easy flow of language and information too.
    • Theoretical analysis might been elaborated

    3. PULMONOLOGY

    Quantitative Assessment : 7/10

    Qualitative Assessment : 
    • Pictorial representation of diagnosis is good.
    • Summary of the case hasn’t been properly elaborated.
    • Must have been more precise about his concern towards the list of drugs.

    4. CNS

    Quantitative Assessment : 6/10

    Qualitative Assessment :
    • Unclear summary.
    • Must have been precise about the diagnosis.

    5. CVS - 1

    Quantitative Assessment : 8/10

    Qualitative Assessment :
    • Elaborated representation on lab tests is impressive.
    • Theoretical analysis is missing.
    • Unclear review about the given treatment.

    6. CVS - 2 

    Quantitative Assessment : 9/10

    Qualitative Assessment :
    • Provided information was clear and precise.
    • Pictorial representation of symptoms is appreciated.

    7. CVS - 3

    Quantitative Assessment : 8/10

    Qualitative Assessment : 
    • Provided information was clear.
    • In addition, easy to understand. 
    • Diagnosis must have been emphasised accordingly. 

    8. GIT - 2

    Quantitative Assessment : 8/10

    Qualitative Assessment :
    • Summary is well explained 
    • Flow charts and pictures would have been helpful to understand.

    9. NEPHROLOGY 

    Quantitative Assessment : 9/10

    Qualitative Assessment :
    • Summary of the case is clear and easy to understand.
    • Differential diagnosis of the case hasn’t been emphasised.

    10. GIT - 3

    Quantitative Assessment : 8/10

    Qualitative Assessment :
    • Timeline and detailing has been clear.
    • Improper emphasis on findings and follow up treatment. 



    QUESTION 2 (Own Case Report)

    The Case report (tap here) reveals about a 57 year old man complaining of burning sensation all over the body which has been diagnosed as Neuropathic Pain post febrile illness due to infection from chikungunya. 




    QUESTION 3 (Peer Review on completeness, accuracy and usefulness of collected patient data).

     Following 11 case details have been reviewed based on above criteria 


    Positives:  
    • Case sheet is novel and ethically sound, as patient is completely deindentified
    • History of present illness is clear
    • Treatment list is properly emphasised 
    Negatives : 
    • Personal history is missing.
    • AKD is associated with alcohol and tobacco abuse which isnt listed.



    Positives:
    • Case sheet is novel and ethically sound, as the patient is deidentified.
    • History taking is very clear and precise.
    • Update on follow up treatment is appreciative
    Negatives:
    • I could not find any factors to improve upon in this case report.



    Positives:
    • Case sheet is novel and ethically sound.
    • History taking is clear
    • Details on investigations ordered are precise and clear
    Negatives:

    Positives:
    • Case sheet is ethically sound
    • History taking is clear
    •  Input of information is organised 
    Negatives:
    • Title of the blog can be improved
    • Personal history absent



    Positives:
    • Case sheet is ethically sound and novel.
    • Input of information is properly organised for easy flow of understanding.
    • CBP and Bacterial sensitivity tests done to rule out infection causing hepatic encephalopathy. 
    • Follow up treatment listed is appreciative.
    Negatives:
    • I could not find any factors to improve upon in this case report.




    Positives:
    • Case sheet is novel and ethically sound.
    • Title of the blog is justifying.
    • Detailed and precise input of information in an organised way.
    • Language is free flowing and easy to understand.
    • Periodic updates on lab investigations is appreciated.
    • Non contrast CT KUB in approaching provisional diagnosis 
    Negatives:
    • I could not find any factors to improve upon in this case report.




    Positives:
    • Case sheet is novel and ethically sound
    • Detailed history taking and processed it in a quite organised manner.
    • Periodic and sequential input of lab investigations.
    • Pulmonary Function Test to rule out Respiratory complications.
    Negatives:
    • No pictures demonstrating  edema of feet as mentioned in general examination.
    • Treatment history not mentioned 



    Positives:
    • Case sheet is novel and ethically sound.
    • Pictorial representation of patients signs and symptoms is emphasised.
    • Periodic input  of investigations ordered.
     Negatives:
    • Could have made it in a more organised manner making it easier to understand and free flowing. 
    • Systematic input of information following the investigation would be helpful.
    • No treatment history and personal history mentioned.



    Positives:
    • Case sheet is novel and ethically sound.
    • Title of the blog is justifying.
    • Detailed pictoral information on patient’s General examination results.
    • Periodic update on given treatment and consecutive results.
    Negatives:
    • I could not find any factors to improve upon in this case report.




    Positives:
    • Case sheet is novel and ethically sound.
    • History taking is consistent and clear.
    • Title of the case is justifying.
    • Periodic input of investigations ordered, treatment given and coresponding results.
    Negatives:
    • Pictures demonstrating b/l edema of feet are absent.
    • No pictures demonstrating pallor either.



    Positives:
    • Case sheet is novel and ethically sound.
    • Summary at the end is helpful
    • Periodic updates on treatment is clear.
    Negatives:
    • Pictures demonstrating distended abdomen, pedel edema are absent.
    • Information is disorganised making it unclear.




    QUESTION 4 (Patient problems and Solutions)

    I have attached the photos of the following answer, because i got more convenient with manual scripts.


    Case 1. 





    Case 2. 





    Case 3. 





    Case 4.





    Case 5.





    Case 6.






    Case 7. 





    Case 8.




    • In patients with chronic kidney disease, development of thrombocytopenia can pose additional problems because an increased risk of arterial and venous thrombosis associated with the kidney disease has to be balanced with the increased risk of bleeding from the low platelet count. 
    • In addition, patients with chronic renal impairment have asso- ciated platelet dysfunction, which enhances the bleeding risk.
    • Erythropoietin, the primary regulator of red cell production, has been shown to improve platelet production and function in experimental studies.
    *Click Here for detailed study of the above research*



    Case 9. 





    Case 10.





    Case 11. 







    QUESTION 5 (Reflective Writing)

    This month has been quite educative and explorative for me. My first history taking case. Irony is, I didn’t have a proper understanding about the basis of taking history from the patients and affective skills and how to come out with a complete history of patient in order to identify one’s disease. But somehow i battled that issue with the help of my peers and seniors. After a detailed practice on history taking among ourselves, then comes the session where I had to do the real history taking with the real patient living in Karimnagar, via tele-consultation.  
    My patient was cooperative and hence me and my friend could finish the process smoothly. First I was worried that I will disturb the patient but then I know I had to do this as this is important in the process of learning and becoming a good doctor the future. During the process that we have to be careful in phrasing our questions, give good verbal and non-verbal cues, differentiate close and open ended questions and ask relevant  question systematically. 
    Examples of open and close ended questions:
    OPEN. 
    1. Rishitha- Why do you think you have prostate problems. 
    Patient- i Dont know mam, its just a feeling. 

    2. Rishitha- What factors alleviate the pain factor. 
    Patient- Stress, anxiety and when under fan/cooler. 

    CLOSE
    1. Rishitha- Do you have any past medical history. 
    Patient- I had been diagnosed with typhoid an year back. 

    2. Rishitha- Are you on any medications. 
    Patient- Presently, i am on homeopathy medication. 

    3. Rishitha- Can you give the complete details of your past drug history. 
    Patient- I will watsapp the same. 

    4. When did the problem start. 
    5. Where do you live.

    After the history taking was done we had to present the case to our facilitator, Dr Sreeja. We did the presentation well but still there were some mistakes that we had made. Dr. Sreeja has helped us correct our mistakes and somehow came out with the right diagnosis. 

    Some mistakes which Dr. Sreeja has helped me in. 
    1. Explained me in detail as to how i reach out the patient about his prostate problem when he denied the same. 
    LEARNING OPPORTUNITY:
    - some patients tend to get uncomfortable when asked particular questions. So making the patient comfortable enough by asking relevant questions and symptoms may help. 

    2. Forgot to take in the details of his daily routine. Dr. Sreeja reminded me the same. 
    LEARNING OPPORTUNITY:
    - Daily routine and lifestyle details are really important factor to diagnose the underlying condition.

    The expansion of tele-medicine and remote access of patients during the COVID-19 pandemic is an opportunity for reflection on its potential in the field. Getting exposure to the ICU, general wards, seeing 10 different patients in a span of just 2 hours, each with their own unique set of symptoms, has motivated me once more to put my all into my studies. Reading endlessly has become monotonous and I have honestly lost sight of why I had chosen this line initially. For me telemedicine has been a much needed light at the end of a dark tunnel.

    These are unprecedented times. Although the necessary focus has been to care for patients and communities, the emergence of COVID-19 has disrupted medical education and requires intense and prompt attention from medical educators. The challenge is in providing authentic patient experiences for medical students as a key component of medical education under these circumstances. Dr. Rakesh Biswas and his team have been doing absolutely great trying to provide the same. They have been working hard by getting us exposed to every new case and by engaging us to transcribe the work into blogs. 
    All this have been satisfactory enough but offline classes and postings is what I have been longing for. 






























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