THE "CORRECT" METHOD

 

From one’s childhood one is taught the correct method for a number of activities like the correct method to brush, to tie shoelaces or to fold clothes neatly. We absorb these methods by seeing our family, teachers and friends and being able to do such day-to-day activities properly and independently improves us and makes life easier. MBBS is no different in this regard. A medico is supposed to learn the correct method of patient examination by carefully examining their professors and Post Graduate Trainees (PGTs) so that day-to-day patient care gets easier and more effective.

One learns the correct method to palpate a patient’s organs or the best way to elicit reflex responses from a patient. One also learns the best method to coax a crying child to measure his head circumference (Pro tip: Singing about "Washing Powder Nirma" might help sometimes.) or the correct method to wash one's hands in six not-so-quick and not-so-easy steps.

While one spends a lot of time and energy trying to acquire these skills in the ward convincing unwilling patients to cooperate with the learning process, or reads standard textbooks to know the universally accepted methods of clinical examination, in the end the only realization that hits hard during Final examinations is that there is no such thing as “correct method” or “accepted method”.

One can learn or practice a particular method but will it be accepted as “the correct method”? Well, that depends on sheer luck. If “your method” is the same as “examiner’s method” then probably yes, but if the two turn out to be even a tiny bit different then “you are not fit to pass”. No matter what you have done throughout the year, only luck can decide whether you will hear praises or go home in tears.

Speaking of “correct method” one wonders “Does the correct method of conducting an examination consist of telling a student that you are unfit to pass right at the beginning of an exam? Why is the exam divided into so many parts if only one viva can decide everything about one’s abilities?” One also wonders why all standard textbooks mention atleast 3-4 methods of palpating organs if there is just one correct method. Ultimately the difference between the “textbook method” and “examiner’s method” or “student’s method” is much like the difference between a language and its various dialects. While language consists of what you say, the dialect mainly refers to the way you pronounce it along with some fine tuning of the words. If one speaks a certain dialect it does not give him or her the right to insult another one. But alas! Life is seldom fair.

How can this problem be solved then? One way can be to bring out SOPs (Standard Operating Procedures) of all the different clinical examination methods alongwith videos which the students can follow and the examiners, under no circumstances, can deny. However, this is a huge task and as the saying goes, “Who will bell the cat?” So, students can only continue to suffer while clinicians continue to devise their very own, personalized, “correct methods”.