I apologize for the months-long hiatus, but between burning out my nose hairs with formaldehyde in the anatomy lab and re-learning (and re-forgetting) metabolism for the third time, it's been difficult to find the precious hours for writing. I've never been good at keeping New Year's resolutions, which is why I rarely make them in the first place, but writing more frequently is my one resolution this year. So...um...hi.
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As future health care professionals, we medical students have a certain perversion with things most other people find appalling. A budding medical student's most carnal cravings are usually satisfied during cadaveric dissection labs in the first year. Exploring the nasal cavities? Twenty-inch hacksaw to the skull, please. Leftover green poop falling out of the colon? Tie that bad boy up like a Christmas roast, and then let's cut it out to take a look! Slicing the penis in half? ...Yeah, I'll be in the corner over there. That's just sick. What's wrong with you?
Our ultimate goal, however, isn't to poke around dead people for the rest of our careers. The goal is to help real, live, breathing people improve their qualities of life. Of course, to achieve that, we have to practice on real, live, breathing people. Once in a while, every medical student in the country has to undergo an Objectively Standardized Clinical Examination, or OSCE. These tests are designed to do two things: one, make sure you don't murder your patient while you listen to their lungs, and two, make you sweat bullets for fifteen straight minutes as you over-analyze every little thing you do like a paranoid schizophrenic. Each OSCE involves fumbling your way through some predetermined physical exams on a trained Standardized Patient and a physician breathing down your neck while evaluating your every twitch. No big deal.
Crap. Did he just write something down on his notepad? What did I do wrong? Did I forget to introduce myself? I swear I showered this morning. Is my fly down? Should I not be holding the blood pressure cuff with my mouth? What's that warm, wet feeling radiating down my leg?
We are graded on everything from the obvious, like not accidentally congratulating an obese 75-year-old male on being pregnant or not puncturing the patient's eardrum with an otoscope, to the subjective, such as bedside manner. (Apparently, talking nicely to people actually matters. Who knew?)
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| This is the textbook method to comfort patients. Minimal germ contact. |
As a fun little exercise, a few weeks ago, our professor who coordinates Standardized Patient cases allowed a few students to play patients. I jumped at the opportunity, of course - when else would I be actually sanctioned by the school to make my classmates comically uncomfortable in front of their peers?
I looked at the two-page description for my role. I was to step into the shoes of John Parker, 27-year-old high school baseball/swimming coach with chronic shoulder pain so bad that it was significantly affecting his ability to work, maintain a relationship, and feel any joy at all. Depressed, athletic Caucasian divorcée with two kids who only drinks occasionally? That is precisely the person staring back at me every time I look in the mirror.
Into the small group room I sauntered, nervously going over all the little details of John Parker's life that would inevitably come up during the interview. My classmates stared at me, bollixed, as I walked to the end of the room and took my seat in front of the camera.
"Hey. What...uh...what are you doing here? You're not in our group."
"I'm gonna be your patient today."
"Seriously?"
"Seriously."
I took a deep, refreshing breath of the heavy air of discomfort that had just sunk over the room. Off to a good start already.
Three of my classmates filed out of the room. I mentally prepared myself to tell the same sob story three times for the next half hour. Come on, Gordo. Get sad. American soldiers getting slaughtered in Normandy. A lone balloon rising through the air until it pops, but nobody is there to hear the sound. That fucking Sarah McLachlan PSA against animal cruelty with that three-legged dog and that DAMN "ARMS OF AN ANGEL" SONG. Wow, now I'm REALLY depressed.
Game face.
Knock knock.
"Come in," I replied in a falsely dejected voice.
My first interviewer was my good friend, PortlandMetro. I'm being entirely objective here when I say that the guy straight up belongs in a J. Crew catalog. I'm not even gay and I couldn't help but get lost in his baby blues and his Romney-esque, perfectly coiffed hair.
And, my God, the man has a way with words. I wouldn't have expected any less from a fellow former Scribe. Not only did he know all the right questions and the proper order of questioning for logical flow, but his soft yet confident tone of voice could have convinced me to admit responsibility for the Holocaust. It just wasn't fair.
Twice more, I told my tale to two other classmates, each performance a little different, depending on the questions they chose to ask (and, more importantly, forgot to ask. I'm not judging - every doctor, no matter how seasoned, makes these mistakes). When I first signed up to play a Standardized Patient that week, I merely thought that it was a chance for me to take a break from practice interviewing and to help my classmates out. I now realize that playing a patient also taught me a ton about my own interviewing skills. Obtaining good histories from your patients goes beyond establishing differentials and isolating a diagnosis. Stepping into your patients' minds, even for five minutes, can help explain concepts, convince them to comply with follow-ups, or break bad news in ways that are likely more comfortable and relatable to them. It's a worthwhile exercise and plenty of fun to boot. I can't wait for the sexual history unit - there are just too many great Party Bus stories in my arsenal, waiting to be unleashed.
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