As mentioned in a previous post, our physical diagnosis class has now moved from seeing simulated patients to performing physicals on real patients. Instead of talking to standardized patients in a videotaped exam room and getting feedback from an experienced medical student, we have graduated: now, we are responsible for seeing hospitalized patients, whom we know nothing about, performing a history and physical, and presenting the findings to a Real, Important Doctor.
That’s scary, by the way.
The first time we did this was back in early February. About a half hour before my partner T. and I were supposed to go see our patient, we received an email telling us the name of our patient and where we could find him. The way the system works is the chief resident scans over currently hospitalized patients, picks out a handful that would be cool to see, and sends them to our professor’s assistant. Patients end up going for scans, surgeries, or are even discharged in the interim if they are assigned too far out.
Before heading over, T. and I checked our newly-assigned patient’s chart. The poor guy had abdominal pain and bloody diarrhea. At the time, I knew of exactly zero things that can cause this except for an E. coli infection and a peptic ulcer. His chart mentioned something called “diverticulitis.” I had no idea what this is, nor did I know what a “polyp” is. But they both sound gross.
(I am so far in past tense because we’re currently wrapping up our digestive unit, and I have heard these words before. I still don’t know what a polyp is, but I at least know that it is a thing you sometimes find when you jam a tube up someone’s butthole.)
As we headed up the elevator to our patient’s floor, I realized that we had exactly zero idea what protocol was here. Are we supposed to go straight into the room? Do we have to check with some nurse first? What if the floor attending is prowling the hallways and thinks we know stuff?
We decided we would just pretend like we knew what we were doing and barge in.
As we headed down the hall to our patient’s room, an orderly wheeled a middle-aged man past us in the opposite direction. Our patient was supposed to be a middle-aged man. Uh oh.
We “foamed in,” knocked on the patient’s room, and walked in. “Mr. X?” my partner called. No answer. No patient.
Crap. I bet that guy going the other way was our patient. And worse, now we have to wander out back to where the nurses, who have now figured out we are clueless, are watching us.
“Uh, do you know where we can find Mr. X?” T. asked, as I stood paralyzed by idiocy and embarrassment.
The nurse looked at us with a mixture of pity and contempt. “He just went for a colonoscopy,” he said, as his eyes added, which you would know if you had anything between your ears.
“OHOKAYTHANKSBYE” I blurted out. We left and went to contact the course director for a new patient.
Since that day, our tutor group has had the most phenomenally bad luck catching patients when they’re actually in the room. The next time T. and I went to find a patient, he was being discharged as we interviewed him. The guy was so anxious to get out of the hospital he was putting his shoes on while we were listening to his lungs.
This past week, we headed to our patient room at our assigned time in the regular hospital. When we found the door, we knocked and entered. Inside were two other first-year students who had been assigned the same room by mistake. Oops.
On our way back, we ran into the other half of our tutor group (we’re in fours). They had been assigned a patient in a room that did not exist.
After sorting out the details, my new partner J2 and I we finally went to see a patient in the VA hospital attached to the university.
(If you are for some reason an avid reader of this blog, this is a different “J” than the J of standardized patient fame, hence the “2”.)
It occurred to us en route that we have no access to VA computer systems, and thus are unable to read his chart. So we had a total mystery patient.
I love mysteries!!! Right?!
When we arrived, Mystery Patient was sleeping soundly.
J2 drew the short straw for waking him up. Mystery Patient awakens and takes an immediate dislike to J2.
After a halting interview – he was on “many pills” and had basically no idea why he was in the hospital besides chest pain, and was insistent that he didn’t have any procedures done – I performed the worst physical in the history of first-year physicals. J2 and I ran out of there, back to the safe confines of the student lounge, and tried to talk through what to do.
We present our patient to our tutor, who is sure to judge us both the worst medical students ever, next week.
I hate mysteries.