Sunday, September 18, 2011

Clinical Judgement

Hey there

In medicine, we like to give fancy names to very ordinary things. For example:

Pyrexia = fever
Polydipsia = thirst
Myalgia = muscle pain
Tinitus = ringing sound in ears
Physiological = normal
Gynaecomastia = man boobs
Hirsutism = female moustache
Idiopathic = we have no fucking idea what is causing it

One more term we use is clinical judgement it means, putting the patient’s story and investigations together, making sense of it and trying to come up with a diagnosis and treatment. A lot of the times, it actually means gut feeling, or hunch.

A few days ago I witnessed this first hand. A lady came in with swelling of the neck and no fever. I thought I was a fairly straight forward case and that she was crying because she was over anxious of the situation. I could not make out if her pain was real of if she was just her hyperventilation causing some neurological symptoms.

However, even though she had no signs that she was in serious trouble besides a swollen neck, the consultant used his “clinical judgement” and decided to admit the patient. She ended up growing alpha-haemologic streptococcus in her blood, meaning that she is septic (infection spread to blood and thus, the whole body) and had mediastenitis (infection spread to the mediastinum or sternum and heart and tissues surrounding the area). Within 3 days of admission, she was in bad bad condition, required an urgent CT scan, got transferred to the ICU and is now under the care of the surgeons.

I have no idea if she is now ok or not but I’ll try to find out when I go back to hospital on Monday. If the consultant hadn’t followed his “clinical judgement” she might had been sent home and probably passed on.

This is why he is the consultant and I’m the student. I’m obviously not half as competent and experienced as he is. What I thought was a simple case of throat infection, he thought was life threatening and very well could have saved this lady’s life.

I think this applies greatly to the world of investing as well. It takes years of education and experience to develop an astute clinical judgement. We can use all the indicators and read all the reports in the world but at the end of the day, it is up to you to make sense of the information available to you and make an informed decision.

Another thing that happened was that as soon as the consultant saw the CT scan and a more life threatening diagnosis was considered, he analysed his thought process and tried finding what he could have done better and what he did well. He later said to me, that if it happened again, he probably would have done it the same but pushed for the urgent CT scan harder instead of worrying about radiation exposure which was a completely reasonable consideration.

I guess the only way to develop a good clinical judgement both in investing and in medicine is to get more exposure. More experience and knowledge will hopefully translate into good decision making.

Hope you all have been well! Thanks for reading. As usual, I always appreciate emails and comments.


  1. wow..! readin this made me miss my medicine and surgery postings.. now all my subjects are all dental.
    a word on idiopathic ; makes the doctor look like a idiot n patient is pathetic therefore the word idiopathic.. lol

  2. hahaha nah you cant say that soo li. Some patients have so many problems that the poor doctors dont know how to fix or diagnose them.