If you’re in a hole, stop digging

I was, I thought, doing fairly well up to this stage, and was particularly confident about the cardiovascular station. The examiner then asked me to examine the CVS on what appeared to be a completely well young child.

I started the exam as always, looking for scars and was a bit phased when the child did not have any. Perhaps all of my preparation had been with children who had a decent scar. The child actually had no signs I found until I listened to the chest. There was a loud rough sounding murmur, best heard at the LLSE. I presented my findings, but as to a cause, my mind had gone blank. I told the examiner that the child had pulmonary stenosis. At this stage my examiner raised an eyebrow and asked me why I thought this, at which point i came out with a lot of signs the child did not have, such as cyanosis and radiation to the chest, which differed from those I had previous claimed to have found. I had become a little flustered by this stage, as I was unable to square the signs I had actually found with the disorder I claimed for the child. Finally the mist cleared, and, right at the end of the case, told the examiner that the features much better fitted with a restrictive VSD.

Thinking about this later, it would have been better to have been slower to come to the conclusion I did, and when I realised it was wrong, stopped adding non-existant signs to justify my error.

What i learnt was that it is fine to correct your initial impression, as long as you can justify the change. That clinical medicine makes sense. If you can’t put it together, its probably beyond the MRCPCH level and therefore be more general or bring out the principals.

Filed in War Stories
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