Week 5: And The Oscar Goes To…

          So I just got home from the standardized patient lab (the one I wrote about last week), and I have to say that it was a great experience, but it was not such an easy task to accomplish. I’ll fill you in on today’s events (just remember, the ‘patient’ I am going to speak of is a trained, medical actress, paid by the PA program, not a real patient)…

          I arrived at the standardized patient lab at 12:50 pm, ten minutes before my patient’s scheduled appointment. Eleven other students had scheduled appointments as well, and we were each given one of twelve examination rooms to stand outside of and wait for our cue to begin the patient interaction. At 1:00 pm, an announcement was made over a loudspeaker, informing us to knock on the examination room door and greet our patient. For this first appointment, we would have eighteen minutes to take a comprehensive medical, social, and family history. I knocked on the door, entered the room, and greeted my patient, a middle-aged female. She was very friendly and answered openly and honestly to all of the questions I asked her. Based on her medical history, she seemed to be a healthy and optimistic individual. However, once I completed the questions pertaining to her family history, a distinct pattern of familial breast cancer surfaced, and that’s when things changed a bit…

          Without going into too much detail, sometimes breast and ovarian cancers are passed down from generation to generation within a family. The cause of this pattern is the inheritance of a mutated (dysfunctional) gene (a sequence of DNA) called the BRCA gene. If an individual has a BRCA gene mutation, his or her likelihood of getting breast and/or ovarian (prostate in men) cancer is greater than that of the general population. So, once my patient told me that her mother and grandmother both passed away of breast cancer, I was (as expected) placed in a position to recommend that she be genetically screened for the BRCA gene mutation. After several questions were asked by the patient and answered by me, the patient agreed to get the genetic screening test. I ended the eighteen minute session with a few seconds to spare, reminding the patient to schedule a follow-up appointment in three weeks so we can discuss the results of her genetic screening test. At that point the same voice came over the loudspeaker and instructed us to leave the patient and examination room…

          Two minutes later, again, the same voice came over the loudspeaker informing us that it was currently three weeks later, and we had to complete a follow-up consultation appointment within ten minutes (F.Y.I.–the patient tested positive for the BRCA gene mutation). So, again, I knocked three times on the examination door, entered the room, and sat across from the patient, who was still confident, at ease, and very positive. I calmly stated that she tested positive for the BRCA gene mutation, and her demeanor instantaneously changed. To be honest, prior to this interaction, I was nearly certain that the patient would get extremely upset, and so I was prepared to console and comfort him or her. Instead, my patient’s demeanor transitioned (not a smooth transition) from calm and positive to angry with a strong sense of denial. She first questioned the validity of the test, and then expressed her feelings that it was just impossible for someone of her health to have such a mutation. It was then when I knew that a simple hand on her shoulder was not going to get me through the situation. As I continued informing her of potential management options, she maintained an angry, aggravated attitude. But as we spoke more about her options and we established a feasible management plan, her demeanor changed once again, and she calmed down a bit after I offered her much reassurance. As the appointment neared its end, I told her that there is little in medicine that clinicians can “guarantee,” but that one thing I could guarantee her was my support. The ten minutes had elapsed, and I was informed to leave the room.

          Finally, the actors/actresses called us back into the examination room to give us some feedback on our interactions. My actress said that she sensed my nervousness during the first few minutes of the first appointment, but that I seemed to calm down once we eased into the questioning. She also said that my responses to her questions were comprehensible and that I did very well with the empathy aspect of the interaction. Lastly, she said that it was best that I interpreted her feelings (anger and denial) correctly, because not all situations warrant a pat on the back or a hand on the shoulder. So, overall, the experience was great. I don’t think I have ever shaken or perspired so much in all my life, and in such a short amount of time, but I’m certain that will dissipate with more practice.   

Question of the week: What is the worm-like structure that hangs from the first portion of our large intestine called?

Last week’s answer: The left heart valve (also called the bicuspid or left atrioventricular valve) is also referred to as the mitral valve. 

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