The Unknown Patient: As Opposed to the Textbook Patient

This article was published in the December 2016 newsletter by Doug Smith, CEO, Medical Educator

We often hear feedback from the students indicating what they are being exposed to on a question is different than what is in their textbook. Many times they have been conditioned through school and publisher textbooks that the text is the hymnal and all they need to know is there. As a practitioner of emergency medicine, we know that it is a rare occurrence to run across the “Textbook Patient”.

Let’s first look at what we mean by the term “Textbook Patient”. Typically, this patient has only one condition. They present with vital signs that are consistent with those found in textbooks reference material and at no time would they be taking any medication that would alter those signs or symptoms let alone have a natural anomaly. They do not have any prior history that would confound the assessment or treatment options and they would never present with any combination of injuries or illnesses that require conflicting treatments.

Our patient is usually not the textbook patient. They often have more than one issue and often are on medications or have a prior medical condition. We teach using textbook examples to provide the students with a solid foundation. The standard vital signs, presentations, and singular treatments provide the student with a foundation to build upon. The foundation cannot be the final goal and it would be impossible to teach every permutation available. How do we then prepare the student for the “Unknown Patient”? The answer is by teaching critical thinking.

Critical thinking relies on a solid foundation as a starting point. It also requires a thorough understanding of the principles involved in managing patients. Principles such as “Do No Harm”! It then requires practice in applying these principles and foundational knowledge in a variety of patient presentations that are not textbook examples. Critical thinking encourages ideas that are conflicting and comes to a resolution that is arguably defensible using principles rather than facts. To teach only what is in the text and then to expect the student to be able to function as a minimally competent EMS provider is to fall short of the actual requirements of the job. We must teach “Beyond the Book”.