last week i did one of my teaching stints at the usc medical school. we work with medical students to teach them how to examine the nose and other structures of the face head and neck. we’re not teaching them cosmetic surgery; that is not appropriate for undergraduate medical students. it is appropriate and important for them to understand the anatomy of the structures of the face including the nose the nasal passages and even the sinuses. once you are a specialist – particularly a superspecialist – you forget how difficult it is to master early in your studies even the simple examination of the nose. to be able to coordinate using an instrument to open the nostrils and a light to look in and to understand what you are seeing isn’t so simple when you are only a sophomore or junior medical student. interestingly the technology available hasn’t changed much since i was a medical student; there is just no substitute for some of the simple things that are used that can fit into your pocket. yes the light bulbs are stronger and the batteries last longer but other than that the instruments that comprise the “head and neck diagnostics” for looking into noses ears and eyes haven’t changed much. it is interesting to listen to the students and to observe their amazement when we explain to them that they need to master the examination of the ears and the nose and even the mouth because 25% of human illnesses take place in the head and neck. common things do occur commonly such as the “common cold. ” we train our students to master the techniques of asking the right questions when a patient presents with some symptoms. for example if a patient comes in with a blocked nose it is very important that the young doctor learn to ask about a history of nasal allergies. what about the history of a broken nose? when did you start to have trouble breathing? is it at night only? do you have more trouble in certain environments? for example is arizona better for your nose than california? is it worse in the summer versus the winter? have you been using nose sprays? what medications have you tried? has anything been helpful? you see medical practice has a certain commonality regardless of specialty. the doctor must be a good listener and pose good and meaningful questions. now you know why sir arthur conan doyle a physician was the author of the sherlock holmes books. a wise doctor and a savvy detective follow the same rules.
why should i expect my doctor to be a good listener?