I was asked to take a history from a 13-year-old boy with hypoplastic left heart syndrome who has had operation of his heart in the past and has been getting increasingly short of breath over the past few months. His mother and him were worried about his symptoms.
I explored his symptoms and then went on to ask about family history etc. Mother said there were no significant illnesses in the family.
During the Q and A section, the examiner asked me ‘What do you think about the patient and his mother’s understanding of the situation?’
Then he further went on to ask me about the mother’s occupation. And I replied that I did not ask . He then revealed that the mother was a dinner lady in school and he asked me why he was interested in asking for the mother’s occupation. I replied saying it is important to know about their social situation and to see whether they need any financial help. He then prompted for more answer, which I said what he wanted me to say – ‘to gauge their level of understanding’. And then he said ,’ Exactly’. I felt really uncomfortable from then on and this examiner gave me the impression that he is prejudiced.
And then he asked me whether there are any significant illnesses in the child’s family history. I said no. And he asked ‘The patient’s brothers are autistic.’ And he commented that I did not asked about each of the brothers .
This was my last station and as the bell rang , he said ‘ I hope you have done well in other stations.’ I left the exam feeling somewhat deflated and thought I failed that station. 5 weeks later I found that I actually passed this station at 10 out of 12.
In retrospect, I wish I had ask for more thorough history including occupation, social situation etc. I wish I had asked about each and everyone in the family.
Key Learning Points:
1. Do not feel rushed in history taking and omit the details
2. Remember to ask about smoking , occupation of parents, good family history
3. Try not to argue with examiners