L o g B o o k

2 0 1 1 – 2 0 1 2Name: Jumana Haider

ID: 20100124

Department of Health & Medical Services Dubai Medical College

Group No.: 8

Health Care Center: Al-Twar Health Care Center

Members of The Group:Jumana Haider

Amal LahibBashayer Abdullah

Nastran Raghda Saeed

Name of the Co-ordinators:Dr. ShaimaDr. Ashraf

Introduction to Communication Skills

Date: 25/9/2012Dr. Shaima

A doctor should always start with introducing himself or herself to the patient, to gain more of their trust. Eye contact throughout the entire session is important, as well as listening to what the patient has to say to show them that the doctor cares. Gaining the patient’s trust makes the history taking process much easier, which will help in writing a better report.

Asking open-ended questions helps in taking better history but due to the limited time dedicated for each patient (about 12 minutes) one can guide the patient to tell exactly what they are suffering from.

There are many theories on History Taking, one of which includes S. Davis’ Theory:1. Cause of attendance2. Management of attendance3. Management of acute problem4. Health education

Cause and Management of Attendance:After the greetings and introductions, the cause of attendance of the patient must be made clear for the doctor to know how to proceed from then on. If required, the doctor might perform some examinations on the patient, after taking their consent.

For Upper Respiratory Tract Infection, it is important to ask about smoking history.

Management of Acute Cause:After all signs and symptoms are clear for the doctor, drug(s) may be prescribed as well as home remedies, if available.

Health Education:The doctor can educate the patient better about the disease they are suffering from, to raise awareness about what they can do to limit its’ side effects and live a better life.

Other issues may be brought up, for example, if the patient is obese or a smoker, the doctor can ask if the patient knows of its’ side effects on their daily life. If the patient is aware and comfortable with the way they are, the topic is left to some other time; but if they mention that they previously tried to stop it and improve their lifestyle, the doctor may include more educational tips or even refer them to a specialist who may be able to help. This known as “Opportunistic Health Education”.

Another theory for managing a patient, is the ICE theory:I – Idea: of the patient about what they may be suffering from.

C – Concern: the patient’s concern regarding the disease [worrying over whether it would develop, etc…]

E – Expectations [and Effects]: prescribing the medication, referral to other departments [if required].

There’s also something known as “House Keeping”, where the patient is asked to visit again, within 2-3 days, if their condition worsened. The Signs and Symptoms must be mentioned to warn the patient.

The center follows the SOAP method:S – Subjective: complaint of the patient as well as history taking

O – Objective: what the doctor sees on examination.Proper examination must be done, as per the condition.

A – Assessment: Diagnosis

P – Plan: the doctor’s plan for the best treatment for this case. [Management, referral, education]

Patient 1:A 45-year-old female came suffering from the flu, with cough, watery eyes.Previously she was given Zinat IV and some antibiotics which did not work. Other cough syrups did not show any effect either.

She developed allergies to certain types of food, but her eye allergies go “way back”.On examination, she had:

o Congested throat, o Heart beast are normal, o No abnormal lung soundso Ears are normalo No lymphoid enlargement

Treatment:o The patient was provided with an inhaler. She was told that if her symptoms

improved, then those are mainly signs of allergies.o Home remedies: with breakfast, she can prepare a cup of warm water with 1

tablespoon of honey and ½ a squirted lemon.o She was also asked to prepare water and salt gargles.o An anti-histamine was also provided

Patient 2:A middle-aged female, came suffering from a sore throat along with headache and vertigo but no cough, or a tingling sensation in throat. She took Adol and her symptoms improved. But today, all symptoms relapsed.She also suffered from earache, itching and blurred vision.

On examination:o Tender lymph nodeso Heart beat is normal o Pus accumulation on eardrum.

Treatment:o The patient was given an anti-

histmaineo Cholesterol drug refill

o Anti-fungal cream o Vitamin D check upo Gargles o Referred to an ENT specialisto Adol o And was given a sick leave for the

day.

Diabetic ClinicDate: 17/10/2012Dr. Alsheikh

I. Definition

Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body.

HBA1C level should be <7 If >9 then the patient must be hospitalized

II. Types

Type 1(Insulin Dependent)-Complete Lack of insulin Type 2(Insulin Independent)-insulin resistance Secondary (due to any other disease in the body, e.g. pancreatic and endocrine

diseases or may be drug induced). Gestational diabetes

III. Complications

IV. Treatment/Management

Diet and lifestyle modifications(less sugar in diet and exercise) Regular Fundoscopy Foot care and foot examination Regular Screening of levels of HbA1C

Tests:

I. Diabetic Foot Check: Must inspect foot for any infection, ulceration, callus, swellings Check in between the toes for any abnormalities Ask the patient if they suffer of any pain Use the monofilament [for sensation], it must bend, try it on all toes,

back of the foot and sole of the foot Use the tuning fork to check for the vibration sensation

II. Glucose Blood Test:1. Clean finger tip with alcohol and wait for it to dry2. Take a new strip, unwrap, insert into the machine and make sure not to touch the

end where blood sample is to be put3. Hold the tip of the finger till a good amount of blood collects [it turns red]4. Prick the lateral side of the finger5. Place blood drop on the strip6. Note the reading

Normal Readings: Random: 80 – 120 mg/dL Fasting: 70 -110 mg/dL

Anatomical LandmarksDr. Ashraf

1. Neck: Carotids; External/ internal jugular veins; Sterno-claido-mastoid muscle.

2. Chest:- Heart and its valves, sternum & it parts (body, maniburum sterni, xyphoid process), ribs, Clavicle.- Midclavicular line, angle of Louis, axillary lines, jugular notch.

3- Abdomen:- Regions (divide & check imp. Of each)

To examine; we need to make sure: 1- we are standing on the right side of the patient.

2- you must warm your hands

Vital Signs and General Examination

The Nurse in charge taught us about the vital signs and we later on, tried them among ourselves.

I. Pulse:

Quantity: Measure the rate of the pulse (recorded in beats per minute). Normal is between 60 and 100.Regularity: Is the time between beats constant? Volume: Does the pulse volume (i.e. the subjective sense of fullness) feel normal?

II. Blood Pressure:

It is measured by using a sphygmomanometer The normal Bp

o Systolic (90-140mmHg)o Diastolic (60-90mmHg)

III. Temperature: 

This is generally obtained using an oral thermometer that provides a digital reading when the sensor is placed under the patient's tongue or in the axillary area.

Temperature is measured in either Celsius or Fahrenheit Fever defined as greater than 38-38.5 C or 101-101.5 F. Rectal temperatures, which most closely reflect internal or core

values, are approximately 1 degree F higher than those obtained orally.

IV. Respiratory Rate: 

Respirations are recorded as breaths per minute. They should be counted for at least 30 seconds. Try to do this as surreptitiously as possible so that the patient does not consciously

alter their rate of breathing. This can be done by observing the rise and fall of the patient's hospital gown while

you appear to be taking their pulse. Normal is between 12 and 20.

V. BMI:

The BMI is calculated as weight in kg divided by the square of height (in meters). The World Health Organization has established guidelines for normal (18.5 - 24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (>30 kg/m2) adults.

VI. WAIST AND HIP RATIO:

A waist circumference (88 cm) in women and (102 cm) in men is associated with higher cardio metabolic risk.

Landmarks include: 1) the umbilicus, 2) the midpoint between the lowest rib and the iliac crest, and 3) just above the iliac crest.

The waist is measured at the narrowest part of the waist, between the lowest rib and iliac crest, and the hip circumference is taken at the widest area of the hips at the greatest protuberance of the buttocks. Then simply divide the waist measurement by the hip measurement.

The WHO defines the ratios of >9.0 in men and >8.5 in women as one of the benchmarks for metabolic syndrome.

HypertensionI. Definition [according to the World Health Organization]:

It is a chronic disease of persistently high systemic arterial blood pressure. Based on multiple readings, hypertension is currently defined as when systolic pressure is consistently greater than 140 mm Hg or when diastolic pressure is consistently 90 mm Hg or more. 

Normal blood pressure: less than less than 120/80 mm Hg Pre-hypertension : 120-129/80-89 mm Hg Stage 1 hypertension : 140-159/90-99 mm Hg Stage 2 hypertension : at or greater than 160-179/100-109 mm Hg

II. Causes:

Unknown Alcohol intake Obesity Renal Disease Endocrine Disease (eg.Cushing Syndrome) Pregnancy Drug Induced

III. Risk Factors:

Age over 60 Male sex Race Heredity Salt sensitivity Obesity Inactive lifestyle Heavy alcohol consumption Use of Oral Contraceptives

IV. Complications:

V. Treatment/Management:

Diet and life style modification(less salt and alcohol intake and physical exsercice) Regular cardiovascular screening Treat the underlying cause (if present) -Drug therapy:-

o Sympatholyticso Alpha Blockerso Beta Blockerso ACEIso ARBso Calcium Channel Blockers

Bronchial AsthmaI. Definition:

a chronic inflammatory disorder characterized by cough with mucus and difficulty in breathing.

II. Causes:

Genetic predisposition (Family History) Triggering (environmental) factors

III. Diagnosis:

History of cough, at night or, early morning Fever or, symptoms of any infections, history of allergy (eczema, rhinitis, family history,

house pets, environmental, drug induced)

IV. Examination:

-check for any lung wheezes-reversibility test (peak flow meter), take deep breath then expire forcefully, if the reading is less than 80% of the excepted so the patient is asthmatic, 3 readings of the test are done and a standard is plotted according to the persons best.

V. Management and Treatment:-

Avoid triggering factors Drug Therapy:-

o Bronchodilators (Beta Agonists,anticholinergics and Methyl Xanthines)o Anti-inflammatory (Corticosteroids)o Leukotriene Modifiers o Mast Cell Stabilizers

Provide an inhaler

Check for severity of Asthmatic Attack using:Peak Flow Meter

1. Make sure the pt. is sitting with their backs straight or are standing [why?] to expand the diaphragm.

2. Explain to the pt. [eg. They are new to this] what this “machine” is used for [check how well their lungs function]

3. Ask the patient to take a deep breath4. Make sure the patient’s lips seal the entry [so no gas escapes and to get a better

reading]5. Ask patient to blow as hard and fast as possible6. Ask patient to read the scale7. Must repeat 3 times8. Take the highest # of the 39. Compare results

Reading is compared to:a. Personal reading b. Expected reading

*Personal best is acquired after the pt. records readings for 14 days

Clinical skills Module Phase 2

Name of the center: Al Twar Health ClinicTrainers: Dr. Shaima, Dr. Ashraf

To what extent this clerkship where useful:very useful Average slightly useful Not useful Were objectives clearly stated at the beginning of your training? Yes No Were the objectives achieved? Fully Partially No How well was the training program organized? Excellent Very Good Good Average

Please rate the trainer with respect to the following:Excellent Very Good Good Average

A. Communication: ✓B. Capability/Knowledge: ✓C. Presence ✓D. Skills ✓

What are the strengths of this Rotation?The doctors in charge were very nice They explained everything we need to know and did not complain when we visited the clinic on days other than those set/planned by the college and I appreciate all the help they provided [to cover the objectives and to help with our audit] and the extra effort they put in to help us make up on the rotations we missed.

What are the weaknesses of this Rotation? The center was not aware of the purpose of our visits.

Recommendation for improvements