How to Solve Clinical Cases in MBBS?

Remember the popular TV series "Grey's Anatomy" and its fascinating and sometimes super-crazy medical case studies? In one of the episodes, there was a little girl who could not feel any pain. She proved it to the doctors by letting her classmate hit her with a baseball bat! And that other girl who could hear her internal organs owing to a hole in her ears? As whacky as these may sound when it comes to complex medical cases, they aren't that far-fetched.

Not just while solving complicated clinical cases in medicine but also while assessing seemingly simpler cases, medical students need to have an eye for the smallest details and a knack for problem-solving. This article aims to offer a few valuable tips to help you excel in solving clinical cases during your MBBS journey. But before we move on to the tips, let’s delve into the reasons why case studies are such an effective teaching tool.

Real-World Application: Theory and all are good in medicine, but to actually be able to relate to a medical topic, case studies can help students a lot. When students listen to real-life medical cases, they understand how information in textbooks translates to real-life symptoms and patient care. And they also end up remembering the case and the diagnosis for years.

Clinical Reasoning: When it comes to learning medical facts, a good Q&A session can be an engaging tool. Case studies motivate students to develop their clinical reasoning skills, question diagnoses, read symptoms with a different lens, and make informed decisions.

Patient-Centred Approach: When medical students read books, work on projects, and discuss theories, they do gain a lot of knowledge. However, medical case studies help put the patient at the center. It helps them not just see firsthand what a patient goes through but also consider the social, emotional, and ethical aspects of handling a patient.

Decision-Making: Solving clinical cases encourages medical students to push their boundaries. They begin to learn the pros and cons of a treatment option and start taking patient preferences into account as well.

Here is an example of a clinical case study:

The patient's name is Brianna. During Brianna's 7-year-well visit, her BMI was found to be in the 90th percentile. Note this: There is no family history of myocardial infarction (MI) or hypercholesterolemia. Her mother has been diagnosed with hypertension (HTN), though. Her mother also suffers from Type 2 diabetes mellitus (DM). Both of Brianna’s parents are obese. Brianna hasn’t eaten a vegetable in the last ten years except for potatoes and onions. Her diet is notably high in saturated fats. Based on all this information, which of the following is your diagnosis?

 

1. Brianna is at a healthy weight and requires no further counselling or intervention.

 

2. Brianna should be classified as obese and referred to a dietitian and exercise physiologist. She should also be asked to come for a weekly follow-up with a plan to bring her BMI below the 85th percentile.

 

3. Brianna can be classified as likely to get overweight and should be referred to a dietitian and an exercise physiologist. Monitor her as she slowly loses some weight.

 

4. Recommend a comprehensive lab work-up to evaluate for hypothyroidism and adrenal gland masses.

So, you see, case studies can be a very interactive and engaging medium to teach medical students. Read on to learn how medical students can develop excellent skills to solve clinical cases. The fourth point is our favourite.

Start with the basics.

It may seem obvious, but if you have ever sat in a clinical case lab, you would know how easy it is for students to jump the gun and start asking advanced questions right away. But this approach usually backfires because when students dive into complex parts of the case too soon, they may miss basic but very important information related to the patient and their medical history. Medical problem-solving techniques stem from information. Lots of it. So, ask the patient about the most basic facts related to their disease. Gather as much information as possible. This will ensure your diagnosis stems from solid research.

Don’t miss the little details about the patient.

No matter how often you have done it before, as a medical student solving a clinical case, it’s imperative to listen to the patient very carefully. Take as many details as possible. If a particular piece of information, e.g., the patient's constant depression bothers you even though it’s not directly related to the disease, do not ignore your hunch. Ask questions.

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Get down to the physical examination.

Once you have the history of the patient, get on with a meticulous physical examination to find clues for an underlying condition. At this stage, diagnostic tests will help you not just narrow down your assessment of the condition but also establish a certain level of trust with the patient because, these days, patients like to be informed about everything. They even do their own research.

Differential Diagnosis.

Once you are done with diagnostic tests, don’t be biased toward one diagnosis; be open to a range of possible diagnoses based on the patient's history and the test results. Then, be very systematic and lay out your diagnoses based on their likelihood and severity.

Do thorough research.

While trying to solve clinical cases, you may not get all the answers right away. So, take your time to find solutions. Read medical textbooks, including books on the specific symptoms, if possible. Meet the patient or their family members again, if possible, and ask new questions if that helps. Go through all the blood work, scans, and tests to see if you are not missing something important.

Seek guidance.

Perhaps one of the most important tips for solving clinical cases is not to shy away from reaching out to experts, seniors, your teachers, or lab researchers. Like several other fields in medicine as well, experience and real-world wisdom can offer insights far beyond those offered in textbooks.