When my grandfather attended medical school back in the day, students had very little (if any) hands-on training with patients until the third year, when they rotated through the hospital wards. Medical schools now recognize the imperative to expose their future doctors to doctoring early and often and many advertise “PATIENT CONTACT ON DAY 1!!” as a selling point for their institution, right next to the pictures of smiling attractive young people in white coats fluidly wielding their stethoscopes.
It’s within that context that we had our first true patient contact last week. Because we are qualified to do exactly nothing (except talk in small groups about arrows and boxes connecting to other boxes and sometimes circles, which I think is what biochemistry is), we were asked to take a history from a standardized patient* – an interesting exercise given the only medical conditions we know exist are diabetes, sickle cell disease, and familial colon cancer. Oh and melanoma.
*(A quick aside for those not familiar with the terminology: a standardized patient is a paid actor trained to simulate medical conditions. Or, in this case, to sit in a room and answer comically out-of-order questions from two terrified first year medical students. It’s primarily a way for real doctors to hide our total incompetence from actual patients needing actual medical care until we can at least pretend we know what we’re doing without breaking into a flop sweat.)
We were paired with another medical student and assigned a half-hour block last Thursday for our session. When it was our turn, my classmate J and I signed in to a workstation and waited outside our exam room at the simulation center. Seven other pairs did the same, lined up in the hallway like nervous, white-coat-clad cattle about to be coaxed onto the conveyor belt.
Weird mental image. Sorry.
Just kidding NOT SORRY AT ALL.
A disembodied voice soon announced, “Begin your encounter.” We eight pairs all “foamed in” – a hand hygiene habit we all have to work on, because all of us overdid the foam and flecks of gross-smelling soap went everywhere – and nervously opened the door.
We tiptoed in with greasy/sticky hands and were confronted with our first problem: to shake or not to shake? Not to shake hands with the actor-patient lady is rude, but at the same time my hands had the consistency of Crisco. No handshake won out.
Another aside: our professor is huge on avoiding the question, “How are you doing?” when you introduce yourself. According to him, it’s a stupid question because if you were doing well you probably wouldn’t be in the exam room.
So we went with “Did you find parking okay?” Absolutely the first thing you want to hear when you’re a patient, right? At least it wasn’t the how-are-you-doing-TERRIBLE-WHY-WOULD-YOU-ASK-THAT experience.
J started with the first part of the history, called “History of Present Illness.” It boils down to “why are you here” and we’re supposed to ask open-ended questions.
We did really well – or more accurately, my partner did. HPI can take the most amount of time, so after she finished up I took over the rest of the history, which includes three big chunks of information: past medical history, family medical history, and social history.
By the way, I’m being intentionally vague about the patient because of HIPAA:
(I may have thrown in the HIPAA sentence JUST so I could use that picture. Again, sorry I’m not sorry.)
Past medical history was easy. I thought. “Do you, uh, have or have you, um, had any medical problems in the past?” SUCH AN EASY- oh, that was a close-ended question. Fail. Also, she said no, so that was the end of that line of questioning. Oops.
Family medical history can be a tough one, because there’s often no reason to take one. If you fall out of a tree and break your arm, I probably don’t really need to know if your uncle on your mom’s side has hypertension.
But the family part was relevant for this encounter, so I kept going. I had to resist a powerful urge to blurt out, “TELL ME EVERYTHING ABOUT YOUR FAMILY” (open-ended!) while leaning creepily forward in my chair to convey appropriate interest and active listening.
I mean, body language is everything, right?
After a few questions about the actor/patient’s parents and siblings, we hurriedly moved on to the last section, social history. I asked about her job, her kids, and her stress level. On my little cheat sheet, the next question was about illegal drug use. My thought process was, “NOPE NOPE NOPE.”
Instead I said, “gotta go!” and we ran out of the room.
Afterward, we had a short debrief session with a fourth-year medical student who was watching us on video the whole time (gulp). She was one of those overenthusiastic-about-everything people, so it was hard to tell if we were actually incredibly! super! awesome! great! at taking the history, or if that was simply her default level of excitement in general.
We wondered later if the fourth-years were specifically told to be ego-boosting in their comments, since half of the class wanders around the whole day with a Will Ferrell-esque voice in their head yelling “I HAVE NO IDEA WHAT IS GOING ON” and feeling incompetent about pretty much all of life.
Okay, maybe that’s just me. Because, again, biochemistry.
After a very thick layer of compliments in the beginning, she did offer a few constructive comments: Ask more open-ended questions, Nate you need to hold still and stop squirming, stop talking at warp speed, etc. And then one more compliment: I like your tie. #complimentsandwich
When we left the simulation center, I went straight to my locker and put my white coat away. I’m years away from feeling comfortable in that thing.