Presenting a Patient: Lessons from Alice in Wonderland

It is my last week of Internal Medicine, which means several tests, portfolios, and an OSCE. Gotta admit, Internal Med has been harder than usual this year, and I was shaking like a leaf before the exam began today. As you can see, I survived. It actually went reasonably well, so now I just have to worry about passing the written tests.

begin at the beginning

When I’m about to freak out about a difficult case presentation, I always remember the above quote.

One of my favourite doctors, a rheumatologist, always has great ways of imparting knowledge. I first met him in my third year, when I had a patient with Dermatomyositis. Our patient was globally weak and could hardly speak. The doctor proceeded to tell me about The Diving Bell and the Butterfly by Jean Dominique Bauby. Since then, he has recommended books to me every time I see him. (So you can see why he is one of my favourites!)

But anyway, at a more recent tutorial he gave us a nice pointer regarding patient presentations (especially for OSCEs). Quoting from The Adventures of Alice in Wonderland by Lewis Carroll, he said, “Begin at the beginning, and go on until you come to the end, then: stop.”

This is great advice for any medical student, regardless of rank, because one of the most difficult things in presenting a patient is knowing what is relevant in the story, and to know when is a good time to stop. Stopping at an appropriate time rather than rambling on until the consultant silences you, gives the impression that you know exactly what you are talking about – even if you don’t!

 P.S: I just found this post, from when we had to do our first ever patient presentation. Funny to see how far we have come. Back then it took five of us several attempts to do a history and a physical examination; these days seeing a patient alone is perfectly usual.


  1. Koot Kotze says:

    Cutting for Stone:
    This line features heavily in that quaint little book. Good luck for the last stretch!

  2. Cait says:

    Life lessons from Lewis Carroll! YAY. (Which is, conicidentally, like my favourite classic ever. Hehe.) I think there are tons of epic lessons in all the nonsense, especially from the Cheshire Cat…like isn’t there a quote about you can’t get where you want to go unless you know where you’re going? (I probably hopelessly misquoted that.) XD Anyway! Congrats on passing exams and I hope you do well for the written ones!

  3. chandra says:

    Thanks for sharing this. applies to life in general. .I enjoy all of your posts.

    1. chandra says:

      And good luck with your exam..

  4. harveylisam says:

    My problem with patient presentations is that I always feel (though it may or may not be the truth) that the attending doesn’t want to listen to me. So I try to go as fast as possible haha.

    1. Oh, I know what you mean. I don’t know how much your attendings focus on the Problem Statement, but I find that the more I hone my ability to give a succinct problem statement, the better my presentations go. But most attendings are bound to interrupt at some point – perhaps to unnerve us or maybe just because they want to get to the bottom of things.

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