"Car Talk" still lives in medical education, teaching medical students to diagnose: photos

Ray and Tom Magliozzi, better known as "Click and Clack, The Tappet Brothers", have stopped recording new episodes of NPR Car Talk in 2012.

Tom died shortly after, in 2014. But the spirit of the show remains. And if you visit a doctor's office, you could benefit.

In the end, Ray and Tom's step-by-step approach to diagnose car problems can apply to more than just your old story. A handful of doctors use the show to teach medical students how to diagnose the disease.

"J & # 39; uses Car Talk clips when I teach first-year medical students, "says Dr. Gurpreet Dhaliwal, a professor of medicine at the University of California at San Francisco." I tell them to monitor the key elements of the problem-solving process. "

Dhaliwal is a life Car Talk fan. In one of her favorite episodes, a puzzled woman calls in complaining of having a shock every time she kisses her husband in the car. Ray was quick to find a solution: new tires, which created static electricity.

"I listened Car Talk Dhaliwal recalls: When I was growing up in my dad's car, I did not know the mechanics, but I recognized that two people had a good laugh.

But when he entered the world of professional medicine, the show took on a new meaning.

"I was listening to their podcast every weekend," says Dhaliwal. "One day, I thought to myself:" My God, these guys do the same job as me, they collect the data, define the problem and choose from several solutions. doctor."

Since then, Dhaliwal has played segments of the series in his classes. He uses the clips to teach clinical reasoning – the process used by doctors to make a diagnosis. He even published an essay on his approach in JAMA A few years ago.

Clinical reasoning can be difficult for young students, says Dhaliwal, because doctors often get confusing and incomplete information about their patient. If you are new, it can be difficult to decide what is important and what is not.

Dhaliwal illustrates how clips work in class.

First, the appellant describes his car problems. Dhaliwal will ask students, "What is the main problem that they are trying to solve?" Dhaliwal explains.

In a "Car Talk" case, the problem was that of a 1994 Chevy Lumina emitting a shrill sound.

Then, Ray and Tom take a story.

"It's an old car with 150,000 km," says Dhaliwal. "The major problem when you climb the hill is that you do not get enough fuel when the demand is very high."

Finally, the brothers present a potential solution.

"They realize that there are only two plausible solutions," says Dhaliwal. "Either a dirty fuel filter or bad candles."

According to Dhaliwal, this step-by-step process is exactly what his students need to do at the clinic.

Identify the brand and model, that is, the main problem. Take a story. Consider plausible hypotheses for the solution.

Dhaliwal explains how it could work with a human subject.

"It looks like a healthy, 25-year-old man who's coughing," he says. "They have to find possible solutions to this problem." Could it be due to pneumonia? Could it be a simple virus? Could it take action? as a problem as serious as that of tuberculosis? and as they get more data, they must finally call these things is most likely. "

It's not just the reasoning skills of Ray and Tom that Dhaliwal admires. Another thing he teaches aspiring doctors to imitate is their ability to establish relationships with gaiety, kindness and humility.

And Dhaliwal is not the only one to see a parallel between the two worlds. Dr. Erika Goldstein is Professor Emeritus of the Faculty of Medicine at the University of Washington. Early in his career, Goldstein struggled to find an effective way to teach clinical reasoning to new students.

"One day, I had this revelation," recalls Goldstein. "I listened to the guys in the car [Ray and Tom] analyze a problem, reason on it and make a diagnosis. I did not know anything about cars, but I could follow what they said. "

It was the 90s, before Car Talk was readily available online. Thus, Goldstein began manually recording segments of the radio and playing them during his lectures.

According to Goldstein, many first-year medical students are overwhelmed by their medical school and are afraid to make mistakes. This hesitation can hinder learning. But diagnosing car problems allows students to think about the process in a less stressful environment.

"It decreases the intimidation factor," Goldstein says. "None of them is supposed to be a car mechanic, so they're not afraid to make mistakes when they talk about cars."

While Goldstein and Dhaliwal use the car analogy as a teaching tool, other doctors use it to communicate with their patients. Dhaliwal appoints a colleague, Dr. Gregory E. Brisson, who wrote an essay in the May 2018 issue of Family medicine explaining how he uses car metaphors to discuss sensitive topics.

In the article, Brisson remembers a conversation he had had with a middle-aged male patient who had problems with sexual performance.

The patient, writes Brisson, described his problems as "no really a problem. Things are d & # 39; agreement… but not like when I was younger. "

"He could not bring himself to say it, so I helped him," continues Brisson. "You do not need to go from zero to sixty.You want to go from thirty to sixty and stay on the cruise control a little longer.Is that?"

Although Goldstein thinks that Ray and Tom would have been excellent doctors, there is a habit that students may not want to emulate: their attitude at the bedside

"They would say things like:" If you get into that car and drive it before you check the wheel bearings, you're going to die! " Said Goldstein. "You do not want to say such things when you meet your patients."

Paul Chisholm is an independent science writer in Rapid City, S.D. He is on Twitter at @PaulJChisholm.