​As a medical student, Dr Trevor Tan did clinical rotations in Singapore General Hospital. In this article, he shares how an encounter with a patient during that posting made him ponder deeply about the sixth sense that needs to be developed and honed by physicians. 

"[The patient] stated, 'I'm aware of the diagnosis. I'm not afraid. I've lived a fruitful life and my children are doing well. Nevertheless, I have one request, before I pass on...'"

By Dr Trevor Tan (above), Internal Medicine First-Year Resident, NUHS

I had the privilege of being attached to the Department of Internal Medicine in Singapore General Hospital as a third-year student as part of my clinical rotations. The immense, unfathomable depths and breadths of Internal Medicine was already universally known by all medical students, and my heart was filled with trepidation as I came face-to-face with the reality of experiential, hands-on learning in the wards.

I vividly recall clerking my first ''medical'' case in Ward 63 (now newly revamped) and presenting it to the team doctors on the second day of my posting. She was a 65 year-old lady who presented with several seemingly unrelated symptoms – fever, cough, abdominal pain and diarrhea – all in the course of a week. When my rudimentary clinical examination did not yield any findings, I panicked. How could I propose a treatment plan for the patient if I could not even figure out what illness she was suffering from?

"No amount of theoretical knowledge can replace clinical exposure," he explained.

Having reached the end of my tether, I eventually sheepishly explained to the team that I did not have a clue as to what the diagnosis was, given the haphazard list of complaints. At this, my assigned tutor, Associate Professor William Hwang, smiled gently and said: ''You know, not everything in medicine has to fit together nicely all the time. Because medicine revolves around humanity, there are bound to be variations.''

At this, Prof Hwang went and retook the history from the patient, while re-examining the patient thoroughly. He came to a diagnosis of pneumonia with diarrhea secondary to antibiotics prescribed by the GP and came up with a treatment plan all in the span of a few minutes. This was confirmed by the investigations that were done.

''This is why medicine is more of an art, rather than a science; no amount of theoretical knowledge can replace clinical exposure,'' he explained.

As I contemplated this statement and assimilated myself gradually into ward work over the subsequent weeks, I eventually came to a conclusion: our five physical senses are finely tuned to serve a purpose in assessing patients (with the possible exception of taste, unless, perhaps, someone relishes the saltiness of cerebrospinal fluid), and these five senses have no readily available technological or automated substitute.

It was one encounter with a patient towards the end of my posting that made me ponder deeply about the sixth sense that needs to be developed and honed by physicians...     

At the time, I was also deeply immersed in a book by the admirable Dr Tan Lai Yong, aptly titled ''Two Ears, Two Eyes but only One Mouth.'' The similarities between his and physicians' use of their senses were striking. I also began to realise that actual clinical practice may differ markedly as to what is dictated in official texts. The importance of individualisation and personalisation of medicine to each patient cannot be overstated.

But it was one encounter with a patient towards the end of my posting that made me ponder deeply about the sixth sense that needs to be developed and honed by physicians – heart.

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Mr L was an elderly Chinese gentleman who was admitted due to worsening upper limb weakness and a rash. Given his florid clinical presentation, a diagnosis of dermatomyositis (a type of muscle inflammation with skin rash) was promptly made, with a colonoscopy and CT-scan revealing a large inoperable colorectal tumour in the terminal stage.

I had intended only to observe the patient's clinical features of dermatomyositis and was eager to move on to the next case, but thankfully Mr L's loveable nature won me over. I had the fortune to sit down and talk to him and enquire about his thoughts towards his condition.

He stated with a determined smile: ''I'm aware of the diagnosis. I'm not afraid. I've lived a fruitful life and my children are doing well. Nevertheless, I have one request, before I pass on.''

''What is that? We'll do our best to help.'' I blurted.

At this he broke into a huge grin and said: ''Sing some Karaoke with me and I'll be the happiest that I've been in these couple of days."

And so we did, in spite of my stuttering dialect and grossly inaccurate pronunciation. We managed to belt out several well-known Hokkien singles before patients and ward nurses began to give us puzzled looks. Mr L was discharged well, but I learnt that he passed away a few weeks later.

"Sing some Karaoke with me and I'll be the happiest that I've been in these couple of days."

I guess that without a soul humanity is simply just eking out an existence without comprehending what it means to be truly living life. And as physicians, should we fail to develop our hearts, we would fail to empathise with our patients. We would fail to rejuvenate and replenish their tired and burdened souls, and would be relegated to a task of adding years to life, rather than ensuring life is well lived year by year.

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I am thankful that my clinical mentors during the period, Assoc Prof William Hwang and Dr Teo Su Hooi, have been inspiring mentors in this regard. Their dedication and selflessness towards their patients is highly respectable and they are the kinds of physicians that I wish to emulate one day.

I am confident that with such compassionate clinical staff, SGH will demonstrate continued commitment to its core values of compassion, integrity and collaboration. This will in turn help it to be an esteemed institution of service not just to the local population, but to the rest of the world. Thank you SGH for the learning opportunities and rich experiences!

This article was made possible thanks to facilitation by the SGH Associate Dean’s Office