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Clinical acumen!

Clinical acumen is a skill applied to form a judgment and take a correct decision accordingly. This is the definition of "clinical acumen" by Cambridge English dictionary. Now with experience a lot of us will realise that clinical acumen and good clinical decisions are not the basis of good clinical practice albeit makes a significant part of it. I personally believe it is communication skills. I might rant about a story that I was just told today where clinical acumen although exemplary, still didn't end well. 

In this post I want to give the resources and, the tips and tricks that personally helped me a lot when I first started in the NHS. I also could have potentially used them better. Anyway I will split them to interpersonal skills and resources

Resources:
I believe clinical acumen is built on collecting the data, then assimilating this date and bringing it together then coming to a conclusion that you are going to act upon. So it split in data collection, interpreting it, conclusion and action

Data collection in Medicine is your clinical examination, ecg, CXR, CT head, blood gases and routine bloods

-clinical exam (any text book or videos) 

-Radiologymasterclass.Co.Uk for cxr and CT head tutorials 

-ECG made easy, ECG in clinical practice, life in the fast lane website litfl.Com as you walk around

-blood gases made easy ver low priority to read


Interpretation of the collected data
Best way I believe is the clinical cases but before that there is a book which I think is the best I have come across, it is just algorithms with the most significant clinical signs

-macleod clinical diagnosis (please note, not clinical examinations but clinical diagnosis, it's a different book) 

- e-lfh.org.uk not a big fan but it is the official website and people in imt training will be asked to do some modules from it and in all fairness has some interesting topics

- "clinical problem solving" series of articles by NEJM (can get them through the library, there is one published monthly) can't recommend them highly enough! 

- Oxford case histories series (Real patients and it shows you the approach with focused explanation) 

- rcp medicine podcast, official Royal college of medicine podcasts, usually as a discussion between acute medicine consultant and a registrar about a typical patient coming through the acute medical take and how would they approach the patient


Management 

- uptodate app some trusts offer that for free. The Best! 
- bmj best practice app
- gpnotebook website (or QM which is the application of that website) 
- clinicalkey and msd pro, they have got wealth of info but I use them mainly for video procedures 


Interpersonal skills:
1. Referrals you make to other specialties
Make sure you ask your consultant, what is the question? Why are we referring? Set your expectations right, is it for take over of the patient care? Just remote advice? Or do you want them to come review the patient? Outpatient follow up? If your referral is clear then you will get a clear answer. You will then see the pattern of management from this particular speciality. The most important bit is if they come to review the patient in person, make sure to go around with them, it shows that you are interested, that you care about your patient and that you wanna learn and achieve this holistic approach in Medicine. The cherry on the top if you have some questions as well, the kind of questions that shows you looked up possible management from the perspective of that speciality, that you were thinking about a solution. They will respect your interest and you will build a relationship with those colleagues or in other fancy term "Networking"

2. For radiology discussions, try to go them and have that discussion face to face. If they recommend a specific scan, make sure you understand why is that better than the one you were initially discussing. Don't lie about your referrals and again have specific question, nobody likes it when someone goes to them and says we want that scan cause my consultant asks for it (you can still get the same message across but in a more subtle yet understandable way). 
If you are discussing a scan that is already reported ask as many questions that could potentially help you when you have a look at the scan urself. Alway always (as one of the best regs I worked with used to tell me) look at the images yourself before reading the report. It is always nice to start your line of questioning with "I am just asking for my own learning but.......... Shoot away" 

3. Nurses have been working in this hospital or department Ages before you. They know the system of the workplace, listen to them and don't come off as arguing (lot's of misunderstanding happens because of our cultural difference) so no harm comes from starting ur "argument" sorry I am just new to the trust but what is the trust protocol for doing....... Or for taking covid bloods or PPE on the ward. Don't brush them off and be approachable cause if the patient is getting unwell and they are struggling to approach you then the whole team is in trouble. Also if they like you, they will get your back and support you. One of the first registrars I ever worked with used to say "NHS" is run by nurses and all of the feedback about you comes from them. Obviously that has no implications whatsoever on clinical decisions which are the doctors. 

4. Microbiologists, best discussions! Learnt a lot about antibiotics and their choice from discussing the choices at length! 

5. The mess offers great opportunities for socialising and "networking". Joining the football/squash/basketball hospital teams, is a great way to get to know people in a more relaxed setting, will make you fit in and help you get things done in your work. 

6. Smile and pretend to be composed! 
People only see you from outside! I once received a GRATIX for being calm, smiling and supportive on my oncalls (I hope the supportive part is right) But I am far from smiling or calm on my oncalls (probably so one saw me at the right moment) and I was surprised by that feedback but then I realised people only see the outside of you, no matter how chaotic things are in your head, no one knows about. 

Just a disclaimer, me writing this,(unfortunately) doesn't mean that I  was always successful in following it but I believe those helped me a lot so far. I was struggling to just do normal reading in Medicine and I found that case studies and interaction with my colleagues from other specialties is really interesting and I learnt a lot from them. 

Hope it works for you as well! 


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