Today we saw our first patients. They weren't real patients, don't worry. They wouldn't subject real people to a first year medical students first attempt to take a history. No, they pay people good money to put up with that, and they do there job well.
All we were told to dress professionally (they men have to wear shirt and tie; us women had more choice in the matter) and to wear our white coats at all times. I guess that is what gives us authority. I mean, we are not hiding the fact that we are students, and we don't have a "Dr" in front of our names embroidered on our coats, but we do look pretty spiffy (I don't have a picture yet, but here is me with my stethoscope and my friend Sina). I think it will take some getting used to to not feel like an impostor in that getup, but it will come. Anyway, we were told that we need not worry about getting a real medical history from the patient, and we should not conduct a physical exam, but just to talk to the patients about why they were there, establish rapport, and do our best to make them feel comfortable while getting whatever information we could. We were to walk in, gel sanitize our hands, introduce ourselves, and then wing it.
The eight of us were led down a long hallway lined with numbered doors and told to stand in front of one of them. "The chart is on the door, you can look at that but don't go in until I tell you to, you will have 15 minutes". I felt like a bunch of horses at the gates. On your mark, get set, go. So I knocked on the door, walked in straight past the hand sanitizer and introduced myself to my first fake patient. In my defense, I had just washed my hands five minutes earlier, but I am sure that was check box number one left blank. So I made sure my patient was comfortable and then we got down to business. Her name was Pat Mitchelle (as was every other patient in the building it turns out), a 55 year old woman in for an employment physical. She was fairly healthy, had little family history of disease, and her only complaint was that she had been experiencing some shortness of breath in the past several months and had developed a small cough. OK. Where to go from there? With two weeks under my belt I still don't have the knowledge base to draw from to know what probing questions to ask. Do you exercise regularly? Does the shortness of breath affect your activities? Do you find that it goes away when you stop to rest or does it persist? Without any means to diagnose it was difficult to know where to go with it. She was in for a physical exam, and I wasn't qualified to do one so . . . so we talked a bit about her job change, about her family, about her dog. . . . finally, not knowing what else to say, I said "ok, I think I have enough information, I am going to talk to my attending and the doctor will be in shortly to give your physical". I stood up. "There is one more thing I was wondering about, I am a smoker and I am wondering if that might be connected to the cough". Oh, right, shortness of breath, developing cough, smoker. Another empty checkbox. Why didn't that cross my mind? So I sat back down. How long have you been a smoker? How many a day? Have you ever tried to quit? So we talked about the fact that the symptoms she was experiencing could very well be connected to the smoking and that we would check that out. We talked about her attempts to quit and that we could to connect her with a support group if she was interested or talk about a plan for quitting; that if she was ready to commit that we would encourage her to take the next step and that regardless of the connection to her current symptoms, quitting would be good for her health. Then the 15 minutes were up. I again stood up, told her it was nice to have met her and that I would be sending the doctor in, and left.
Of course once outside the door I was thinking of all the "should've"s and "could've"s for a patient interview. If I was given another one right then I have no doubt I would have done much better, but for my first try I don't think it was so bad. I guess I'll see though. We were all videotaped and the "patients" evaluated us which we will get to see at the end of the month. In any case, it will be very helpful to have experienced the "doctor-patient" interaction when we start learning the right way to do it; so we can look back and think, what was I thinking?
Just a side note, as far as I have gathered from the others that have done the patient encounter, very few of us thought to ask about smoking habits. I think that not having much direct experience with smokers and the health effects in my own life it is not yet an obvious connection to me. I am sure that once I start seeing patients it will become a common theme. And next time I will remember to sanitize my hands.
Posts
1 comment:
chica, you have a great way of narrating your experience. Almost feel like I'm in med school too:) And you know I'm jealous of the scrubs. When will you get me mine?
Post a Comment