To become a syncope doctor

Courtesy of a colleague

Wieling W. My good fortune to become a syncope doctor. Clin Auton Res. 2021 Feb;31(1):15-18. doi: 10.1007/s10286-020-00763-5. Epub 2021 Jan 8. PMID: 33417055.

Excerpt

Due to rapid advances in medical technology, molecular biology, genetics, clinical epidemiology, and evidence based medicine, as well as wide dissemination of electronic records and rapid turnover of patients, the interest in basic bedside medicine and clinical physiology has decreased. Nevertheless, the core bedside skills of careful history taking and physical examination, the backbone of clinical reasoning, remain vital for the evaluation of transient loss of consciousness (T-LOC) and syncope. The skill in diagnosing an unexplained episode of T-LOC/syncope starts with a meticulous documentation of what happened to deduce what is going on with this patient. The key to a successful syncope history is having sufcient knowledge to ask the right questions and taking enough time to listen to the patient intensely. History building with the patient instead of history taking from the patient is key. The patient needs to feel at ease and to trust the doctor, to reveal all important aspects underlying the episode, particularly the ones with psychosocial triggers. Some vital aspects of the history (which the patient may not consider important) need to be “teased out” by the doctor. This skill requires experience as well as a good interviewing technique. Careful history-taking and physiological reasoning are powerful tools to diagnose T-LOC and syncope. The diagnostic yield of a certain or highly likely diagnosis of T-LOC and syncope with history taking by hospital physicians is at least 60% with an accuracy of about 90%. The diagnostic yield can increase to as much as 85–95% with additional historytaking by a doctor with a special interest in syncope. Additional diagnostic testing increases the certainty of the diagnosis, but it does not contribute to improving patient care. The importance of history-taking and its high diagnostic yield implies that history taking must be allotted time. In complex cases, up to 1 h may be required.

A strong formal knowledge structure is needed for a successful interview of a patient with T-LOC and syncope. The Internet can serve as a strong educational tool for students and residents e.g. with a video-library with examples of episodes of reflex syncope. E-learning-based cases (eCases) are a far more effective tool for teaching than learning in a classroom listening to lectures. We have developed Syncopedia (www.syncopedia.org), a free-access educational website targeted at students, residents, and physicians to learn more about syncope. The website is an initiative of the Syncopedia Foundation, a non-proft organization established in the Netherlands in 2014. The goals of the Syncopedia Foundation are “to improve medical knowledge, especially in the field of syncope, and to provide access to this knowledge by facilitating publications in digital or other forms, for example by building and maintaining websites”. The goal of the Syncopedia website is to enhance physicians’ knowledge of syncope (or suspected syncope) and to reduce misdiagnosis, unnecessary testing, and multiple specialist consultations