Often Neglected Guidelines for Clinical Practice, Teaching, and Further Inquiry

The guidelines in this section have been extensively discussed in the past and are included to varying extents in the undergraduate medical curricula. Still, some of them seem to be ignored in clinical practice and teaching, and their re-emphasis may improve medical care. The neglected guidelines for clinical practice are, firstly, the need to identify the patient’s perceptions, concerns, and expectations. Clinicians can enhance their ability to help by making the patient’s main concern, rather than the chief complaint, the starting point for patient management. Second: Rather than being offended when patients seek a second opinion, a doctor should encourage it and schedule a follow-up appointment to deal with possible discrepancies between the first and second opinions, answer the patient’s questions, and provide information. Third, keep in mind that underprivileged patients are at higher risk for morbidity. Mental health problems, mental illness, drug addiction, loneliness, social isolation, and life events are associated with higher overall mortality and morbidity. The neglected guidelines for instruction are, first, teaching basic clinical skills and patient counseling for mastery. Rather than expecting basic clinical skills to improve through repeated reinforcement during clerkship, students would be better served by a single program aimed at teaching patient interviewing, physical examination, self-directed learning, and patient counseling at a level of competency expected of a practicing physician. Secondly, tutors should caution students against unthinkingly imitating role models. No person always exhibits all the characteristics of the ideal clinician. Therefore, students should differentiate between behaviors and not between role models. Thirdly, tutors should promote students’ awareness of medical errors and doctors’ reactions to having committed the error. I suggest including the second victim syndrome in the undergraduate medical curriculum. Students who participate in these programs can receive counseling in an atmosphere where they are not judged but supported as they think about their future careers. Fourth, tutors should communicate to interns and residents that professional hardships are common and not due to individual shortcomings. By setting realistic expectations for medical students, tutors can reduce future stress.