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Here is a structured Clinical Medicine Practice Guide for a learning practitioner. This covers the essential frameworks you need to build strong clinical skills.
🩺 Clinical Medicine Practice Guide for Learning Practitioners
1. THE CLINICAL METHOD — The Foundation
Every patient encounter follows this core framework:
History Taking (Anamnesis)
This is the single most important skill in clinical medicine — up to 80% of diagnoses are made from history alone.
| Component | What to Ask |
|---|---|
| Chief Complaint (CC) | "What brought you in today?" |
| History of Present Illness (HPI) | Use OLDCARTS: Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation, Timing, Severity (0–10) |
| Past Medical History (PMH) | Prior illnesses, hospitalizations, surgeries |
| Drug History | Current medications, dosages, allergies (NKDA?) |
| Family History (FH) | Hereditary conditions (DM, HTN, CAD, cancers) |
| Social History (SH) | Smoking, alcohol, occupation, travel, sexual history |
| Review of Systems (ROS) | Systematic head-to-toe symptom screen |
2. PHYSICAL EXAMINATION — Systematic Approach
Always follow Inspect → Palpate → Percuss → Auscultate (except abdomen: Inspect → Auscultate → Percuss → Palpate).
General Examination
- Vital signs: BP, HR, RR, Temperature, SpO₂, Weight
- General appearance: well/unwell, distressed, pallor, jaundice, cyanosis, edema, clubbing, lymphadenopathy
System-by-System Examination
| System | Key Clinical Signs |
|---|---|
| Cardiovascular | JVP, apex beat, heart sounds (S1/S2/murmurs), peripheral pulses |
| Respiratory | Chest expansion, tracheal deviation, vocal fremitus, percussion note, breath sounds, added sounds (crackles, wheeze) |
| Abdominal | Organomegaly, tenderness, guarding, rigidity, bowel sounds, shifting dullness |
| Neurological | GCS, cranial nerves, motor (power/tone/reflexes), sensory, cerebellar (DANISH) |
| Musculoskeletal | Look–Feel–Move–Special tests |
3. CLINICAL REASONING — Building Your Diagnosis
Use a structured thinking approach:
Step 1: Generate a Problem List
List all abnormal findings from history and exam.
Step 2: Create a Differential Diagnosis
Use VINDICATE or VITAMIN C mnemonics:
- V – Vascular
- I – Infectious/Inflammatory
- N – Neoplastic
- D – Degenerative/Drugs
- I – Idiopathic/Iatrogenic
- C – Congenital
- A – Autoimmune/Allergic
- T – Trauma/Toxic
- E – Endocrine/Metabolic
Step 3: Rank by Probability
"Common things are common" — think of horses before zebras.
Step 4: Rule out Life-Threatening Diagnoses First
Even if rare, always consider:
- Acute MI, PE, Aortic dissection, Meningitis, Sepsis, Stroke
4. COMMON CLINICAL PRESENTATIONS TO MASTER
🫀 Chest Pain — Differential Approach
| Cause | Key Features |
|---|---|
| ACS (MI/Unstable Angina) | Central, crushing, radiation to arm/jaw, sweating, ECG changes |
| Pulmonary Embolism | Pleuritic, sudden onset, dyspnea, tachycardia, risk factors |
| Aortic Dissection | Tearing, radiates to back, BP difference between arms |
| Pericarditis | Sharp, positional (worse lying flat, better leaning forward) |
| GERD/Esophageal | Burning, related to meals, relieved by antacids |
| Pneumothorax | Sudden, unilateral, absent breath sounds |
| Musculoskeletal | Reproducible on palpation |
🌡️ Fever — Diagnostic Approach
First rule out sepsis (qSOFA: altered mentation, RR ≥22, SBP ≤100)
Common causes by system:
- Infectious: UTI, pneumonia, cellulitis, meningitis, endocarditis
- Inflammatory: SLE, RA, IBD
- Neoplastic: Lymphoma ("B symptoms": fever, night sweats, weight loss)
- Drugs: Drug fever (typically 7–10 days after starting medication)
😮💨 Dyspnea (Shortness of Breath)
| Acute | Chronic |
|---|---|
| PE, pneumothorax, asthma attack, flash pulmonary edema, ARDS | COPD, heart failure, interstitial lung disease, anemia |
Key investigations: CXR, ECG, ABG/SpO₂, CBC, BNP, D-dimer (if PE suspected)
🧠 Altered Consciousness — AEIOU-TIPS Mnemonic
| Letter | Cause |
|---|---|
| A | Alcohol/Acidosis |
| E | Epilepsy/Electrolytes |
| I | Insulin (hypo/hyperglycemia) |
| O | Overdose/Opiates |
| U | Uremia |
| T | Trauma/Temperature |
| I | Infection (meningitis, sepsis) |
| P | Psychiatric/Poisoning |
| S | Stroke/Structural/Shock |
5. ESSENTIAL INVESTIGATIONS TO KNOW
| Test | Interpret for |
|---|---|
| CBC | Anemia, infection (WBC), thrombocytopenia |
| BMP/CMP | Electrolytes, renal function (creatinine, BUN), LFTs, glucose |
| ECG | STEMI (ST elevation), arrhythmias, LVH, PE (S1Q3T3) |
| CXR | Pneumonia (consolidation), heart failure (cardiomegaly, pulmonary edema), pneumothorax |
| Urinalysis | UTI (nitrites, leukocytes), proteinuria, hematuria |
| Blood Cultures | Before antibiotics in suspected sepsis |
| ABG | Respiratory vs. metabolic acidosis/alkalosis |
6. PRESCRIBING BASICS — The WHO Guide to Good Prescribing
Follow the 5 Rights of Prescribing:
- Right patient
- Right drug
- Right dose
- Right route
- Right time
Writing a Prescription Includes:
- Patient name, date, age/weight
- Drug name (generic preferred)
- Dose, route (PO/IV/IM/SC), frequency
- Duration
- Your signature and registration number
7. CLINICAL PHARMACOLOGY — Drug Classes to Master
| Class | Examples | Key Use |
|---|---|---|
| Beta-blockers | Metoprolol, Atenolol | HTN, ACS, heart failure |
| ACE Inhibitors | Enalapril, Lisinopril | HTN, heart failure, CKD |
| Statins | Atorvastatin, Rosuvastatin | Dyslipidemia, CV prevention |
| Antibiotics | Amoxicillin, Ciprofloxacin, Azithromycin | Bacterial infections |
| Analgesics | Paracetamol, NSAIDs, Opioids | WHO pain ladder |
| Diuretics | Furosemide (loop), HCTZ (thiazide), Spironolactone | Edema, HTN, heart failure |
| Bronchodilators | Salbutamol (SABA), Tiotropium (LAMA) | Asthma, COPD |
| Insulin | Rapid, intermediate, long-acting | Diabetes management |
8. PRACTICE TIPS FOR LEARNING PRACTITIONERS
- See patients every day — clinical skills only improve with volume
- Present cases aloud — practice the SOAP format (Subjective, Objective, Assessment, Plan)
- Know your emergency drugs cold — Adrenaline, Atropine, Nitroglycerin, Morphine, Glucose
- Master the ECG — it is the most important bedside test in medicine
- Read Harrison's Principles or Kumar & Clark — these are the gold-standard clinical medicine textbooks
- Follow evidence-based guidelines — WHO, UpToDate, NICE, ACC/AHA
- Always wash hands — infection control saves lives
- Reflect on every case — "What did I miss? What would I do differently?"
9. SOAP NOTE FORMAT — Clinical Documentation
S (Subjective): What the patient tells you
O (Objective): Vital signs, physical exam findings, lab/imaging results
A (Assessment): Your diagnosis or differential diagnosis
P (Plan): Investigations ordered, treatment started, referrals, follow-up
10. MEDICAL EMERGENCY MNEMONICS
| Emergency | Mnemonic/Approach |
|---|---|
| BLS/CPR | CAB — Compressions, Airway, Breathing |
| Anaphylaxis | Adrenaline IM 0.5mg → Antihistamine → Steroids → IV fluids |
| Stroke | FAST — Face, Arm, Speech, Time (call stroke team) |
| Hypoglycemia | Check glucose → Give 15g fast carbs or IV Dextrose 50% |
| Sepsis | Sepsis 6: O₂, Blood cultures, Antibiotics, IV fluids, Lactate, Urine output |
This guide gives you the core clinical framework every practitioner needs. Would you like me to go deeper into any specific topic — such as a particular disease, drug class, ECG interpretation, or clinical case scenarios?
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