“Technology is not a replacement for history-taking in reaching a patient diagnosis,” says Clinical Associate Professor Viali Lameko, MBBS, MIPH, PhD Candidate, Dean for Samoa and the South Pacific at Oceania University of Medicine.
“Every physician would agree that history-taking is the most important part of clinical assessment and there is a basic structure to a patient interview. However, the method, technique and skills used to obtain the history varies among physicians,” says Dr. Lameko. He went on to say that with limited technologies available at Tupua Tamasese Meaole Hospital (TTM), OUM’s primary teaching facility located in Apia, Samoa — there is no MRI, cath lab, or portable EKG unit — a comprehensive physical exam is “still the way to go.”
Clinical Associate Professor Lameko recommends:
- Master the technique of auscultating for heart murmurs and extra heart sounds using a stethoscope, a vitally important skill for evaluating for congestive heart failure in the absence of EKG.
- Evaluate central venous pressure by assessing the height of the jugular venous pressure, which can be done during examination by elevating a patient’s head and neck with pillows.
- Assure a thorough evaluation of chest pain by following SOCRATES – Site, Onset, Character, Radiation, Aggravating factors, Timing and associated symptoms, Elimination factors, Severity.
All OUM students are required to complete at least one 4-week elective clinical rotation in Samoa. As the attending physician responsible for OUM’s Internal Medicine (IM) rotation, students who take the IM clerkship in Samoa will see Dr. Lameko every morning for rounds, Monday through Friday. He shared the types of procedures medical students perform in Samoa, under the watchful eye of medical faculty, which many countries don’t allow until medical school is completed and the physician is in post-graduate training.
OUM students have the opportunity to set up IV lines, remove fluid from a patient’s lungs or abdomen, intubate for anesthesia, put in a chest tube during surgery, and assist in the delivery of normal vaginal births.
Dr. Lameko explained that as part of this important procedural training, OUM’s clinical students spend a lot of time with patients at the bedside, which perfects a doctor’s assessment skills.
“Reaching a diagnosis without the advantage of technology is a vitally important clinical skill,” says Dr. Lameko. “It is also rewarding, challenging and sometimes, even fun.”
Located on the grounds of the National Health Complex in Apia, Samoa, OUM is accredited by the Philippine Accrediting Association of Schools, Colleges and Universities, listed in the World Health Organization’s World Directory of Medical Schools, and recognized by the Education Commission for Foreign Medical Graduates. Having passed their respective licensing examinations, OUM graduates currently practice medicine in Australia, Canada, New Zealand, Samoa, and the US.