Stanford 25 Perspectives

October 30, 2024

Michelle Chiu, MD, a Clinical Assistant Professor in Stanford's Department of Medicine, has built her career around the art and science of bedside medicine. With a background in hospital medicine, Chiu brings a patient-centered approach to her practice. Her passion for connecting with patients led her to become involved with Stanford Medicine 25, an initiative dedicated to revitalizing bedside medicine skills among clinicians. In this interview, she shares insights into her journey, her approach to teaching, and the vital role bedside medicine plays in enhancing patient care.

Can you tell us about the new curriculum you're developing and how it incorporates the principles of bedside medicine from Stanford Medicine 25?

The curriculum is called Med 254: IM Bedside Clinical Reasoning and Physicals Diagnosis Rounds. It is the brainchild of a then second-year medical student who saw a gap in their curriculum. Together we developed the course’s curriculum, which seeks to bridge concepts across clinical reasoning, practicum, and pathophysiology. 

Medical and physician associate (PA) students rotate together through 2-3 patients currently admitted at Stanford Hospital to improve their physical exam skills and discover how pathology manifests in the clinical context. Stanford Medicine 25 is heavily represented in the pre-reading material for each session. Many of the course’s goals are one-in-the-same as Stanford Medicine 25’s- to enhance bedside medicine skills and improve patient care. I hope the students discover how the physical exam is an essential tool and teach them a patient-first approach for their future careers. 

Could you share a memorable experience or patient story that highlights the importance of bedside medicine in your practice?

There are many stories that come to mind where a simple exam could have saved the patient unnecessary tests, interventions, or even procedures. Recently I had a patient whose nurse contacted the treatment team about a low blood pressure reading and the team rushed to order IV fluids before seeing the patient. When we arrive later to bedside, we note that they are warm, well-perfused, and have significant lower extremity swelling. The patient tells us their blood pressure always runs low. In this case the patient had heart failure with reduced ejection fraction- a quick exam and discussion with the patient would have told us that fluids would only make his condition worse.

What specific skills or techniques from Stanford 25 do you find most valuable in day-to-day patient care?

Recently I’ve been referencing the point-of-care-ultrasound videos often as I aim to improve my own technique and help teach trainees.

As a member of the Stanford 25, how do you integrate bedside teaching into your clinical rounds with trainees?

Bedside teaching can be a daunting prospect on a busy service; it’s important to make it manageable and useful. I focus on small and digestible teaching moments during rounds with trainees. Rather than trying to complete a full exam together for every patient on our list, I highlight brief teaching moments for select patients. This can be as simple as discussing how to describe a rash or demonstrating one aspect of the neurology exam.

What advice would you give to medical students or residents on honing their bedside examination skills?

Don’t be discouraged! Real patients are never as straightforward as the textbooks will suggest; everyone has different anatomy and sometimes it can be frustrating to practice skills and not get the result you expected. Keep working on your skills and remember, the patient can be an invaluable asset to your learning. Many times the patient will know what exam findings they have and/or if adjustments had to be made to elicit them in the past.