Being judgemental

I had a great day yesterday at hospital. In fact most of the time spent on the Emergency Admission Unit (EAU) had been good. I've seen five lumbar puncture now (including two from my previous attachment) and the house officer said when the next one comes I can do it! I was in the ward from 0830 - 2100 yesterday. Saw amazing things: two LPs, ascites tap, elicited shifting dullness, SVC obstruction, and got my first ever successful blood gas! One of the lady which we did LP (whose CSF was a little yellow) on turn out to have subarachnoid haemorrhage, which was totally unexpected! So I got a free teaching on SAH since the house officer who did it was all too excited. The doctors kept telling me to go home but first it was raining outside all day and secondly there's so many interesting things to see how could it let such rare opportunity slip?

But I wasn't too happy about myself yesterday. This is kind of like a reflective thing. I clerked a patient who came in with collapse. He is a widower living alone who was just discharged from this ward yesterday morning and who reluctant to go home. The house officer was mourning about him suggesting that this must be an inappropriate referral. So, having the idea in my mind I did not really concentrate hard when I talked to him. And I thought his symptoms was so all over the place - non specific dizzyness, weakness, loss of balance, blurring of vision, tingling for a year or so. I quickly swept through the CV and resp examination which was nad in my opinion. I was reluctant to do a neurological examination because I can't do it properly yet, but the registrar insisted. So I did it. He kept telling me that there is weakness on the left side of his arms and legs but I thought the power was equal on both sides except for his hand grip on the left, and there was also a loss of sensation on the left foot. Finger to nose and heel to shin were ok but slow on the left. Visual field testing was so difficult with him because it was so grossly abnormal and I didn't want to repeat it because I just can't intepret the finding it all. So in the clerking sheet I wrote: 'Impression: I don't know, it's way out of my depth!'. In my mind, I thought he just can't cope living alone and trying to get attention by these psychologically induced signs. How wrong was I! When the registrar and consultant repeated the examination, they found clear cerebellar signs (nystagmus, buzzing noise in the left ear, abnormal left finger-to-nose and supination-pronation, left homonymous hemianopia, romberg positive). So he might have had a posterior circulation stroke or worse an intracranial lesion and would need a CT scan of the head. I was extremely ashame of myself. Not because I failed to elicit those signs (they were honestly out of my depth), but because I made a judgement of a patient even before I talked to him. I was already thinking that it must all have come from his mind. I didn't take his concerns seriously. And I thought he was faking the loss of sensation and stuff. All because he had just been discharged on the day itself, is a (miserable) widower and smells. How can I be a good doctor when I'm already such a judgemental person as a medical student? I found it difficult to believe that I'm actually this kind of person - ignorant and arrogant. If I have been a qualified doctor with the same attitude who clerked this patient, I could have let a man with an acute stroke go home with a 'heartsink' diagnosis. Why did I think that way? Partly it's me trying to conform to the views of the other doctors - you know how sometimes doctors would look at the patient's background and presenting complaint, and straight away say 'this must be a time waster' or something like that. But I cannot do that. I'm not experienced enough. And I mustn't ever do that even when I'm already well experienced. Judging someone from the surface is a dangerous thing to do. I should have know that.