I See Actual Patients Now

In an effort to keep us from looking completely ignorant in a few short months when we start our rotations, our school has implemented a “pre-clerkship” rotation where they show us the ropes for 3rd year in a low stress, low responsibility environment. A group of four students are paired with an attending physician and tasked with seeing a single patient, taking a history, doing a physical exam, and writing a note on the patient. You may recognize this as a pretty routine task in medicine. The reason I mentioned that this is a “low-stress” activity is because we were given 4 hours to do it.

In reality, it wasn’t that bad. The worst part was the walking. My group has two girls in it. One is under five feet tall, the other is maybe an inch taller than my petite wife. The other male medical student is from Kuwait and is maybe 5’8″, and he stands taller than our elderly attending. Now, I am fairly convinced that I am an average sized American male, but at 6’2 and 200lbs I felt like a yeti lumbering around the hospital with this group. It was worse when we all packed into the room, because they seemed to find all of the corners and wall spots, while I was stuck standing in the middle of the room with my head bent to avoid the ceiling mounted television.

That was the worst part. At first I wasn’t even doing anything except taking up space (the only marketable job skill I have after 6 years of schooling, for those of you taking score). I just took notes while one of the girls started taking a history from this elderly guy in the hospital for bowel problems. She started out terrifically, but ran out of steam after asking “So what brought you in to the hospital today?” She starts to flounder and get flustered and look at the floor, and the doctor is helping her along very gently and nicely. So I am slowly jotting important notes, thinking about how lucky I am that I get to be the note taking yeti this week, and the attending turns to me and says “Why don’t you jump in and finish the history?”

So I switch places with the girl, because we both know that his question was more like a command, and I pick up with the history. I know he told me to “finish” the history, but since she had just barely started it turned in to something more like “do all of it while we watch”. I did a fairly good job. I learned some better ways to ask questions, areas I need to focus more on, and in general had a fine educational experience. I feel like this guy was a great patient to interview, because his medical history looked like the table of contents in a pathology textbook. Multiple cancers, cardiac problems, lung problems, vascular problems, a couple dozen operations for a variety of issues. I got to hear all about all of it because the attending wanted me to do a review of systems and explore all positive answers, so that only took like 30 extra minutes. Shockingly, this guy still had perfect vision. Everything else in the world was wrong with him, but at 76 years old he didn’t need glasses or contacts.

So now we (I) have spent an hour talking to this guy and his family shows up for a visit. I am (finally) done taking this history, but the doctor also wants me to do the physical as well. A complete physical. Remember, we are supposed to splitting duties equally among the four people in the group, and so far I’ve done most of it. I ask how much of the complete physical exam we need to submit this poor guy to (pretty sure this guy has had enough stuff inserted into his rectum in the last few days), but the doctor tells me to do “most of it” and then steps outside to take a phone call. I fumbled through “most” of a physical exam, sparing him (and me) the really awkward parts, and we finished up early.

Even if it’s awkward seeing patients when we have little (or none at all) medical expertise, it’s certainly better than studying, which I should be doing right now. I’m looking forward to 3rd year because I get to leave the lecture halls and start seeing actual patients, which is the whole reason I got into medicine in the first place. This particular day was a good example of how we can “fake it till you make it”. When that patients family showed up to visit, they totally thought we were legitimate medical practitioners. All they saw was a group of white coats around his bed. What they should have seen was a bunch of hesitant newbies trying to figure out how to do this whole doctor thing.

Also, I get way better stories in the hospital. It’s hard to blog about studying for 8+ hours a day.

Thanks for reading!

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