Note: The “patients” I speak of are actors/actresses hired and trained to simulate real patient encounters.
I remember learning how to ride my first bike. It started easy, with four wheels: two bike wheels and two training wheels. Over time, little by little, inch by inch, my parents would gradually raise the training wheels. With each incremental rise, I would wobble for some time, struggling to maintain my balance, but I would eventually adapt to each change. After much practice, the training wheels were finally safe to remove, and, at last, I was proudly riding my, now, two-wheeled bike…
Tuesday afternoon, we received details about the standardized patient lab we would all be participating in three days later (today). No longer would we have one patient to interview, examine, and diagnose, as expected, but we would rather have two appointments and therefore two separate patient encounters, twenty minutes each. We would not know until speaking with the patient what he or she has scheduled the appointment for, and so, all of the thinking, questioning, and examining would have to be determined on the spot. Unlike the gradual rising of the training wheels on my bike in childhood, I quickly discovered that my PA school training wheels rise much more quickly. And so, today, I found myself standing in front of exam room #9, stethoscope around my neck, waiting to meet my first of two patients. When prompted, I knocked on the exam door three times, and cast my training wheels aside…
My first patient, a middle-aged male, was very pleasant and friendly. He scheduled his appointment for loss of hearing and aching of his right ear with an associated frontal headache. Within seconds of hearing his complaint, I began to think of the most likely causes for his symptoms, like an outer or middle ear infection or preceding sinus infection, for example. After eliciting specific information about his symptoms, it became a bit more clear that the symptoms he was experiencing were likely the result of seasonal allergies. Following the interview, I performed most of the physical exam techniques that I learned in my Clinical Skills class, just to assess his ears, hearing, nose, sinuses, lymph nodes, and throat. The only stumble, in fact, three stumbles, that occurred during this first encounter was due to the uncooperative nature of the earpieces I tried to attach to my otoscope. For some reason, those darn things didn’t want to snap on to the otoscope, as they usually do, and three earpieces in a row popped off of the otoscope and onto the floor before even making it into the patient’s ear. Fortunately, I was able to brush off the stumbles, and I surprisingly still have some earpieces to spare!
Upon entering the second exam room, my second patient, another middle-aged male, appeared to be in bit more pain and distress. He had much difficulty responding to my first question: “tell me, what brings you in today?” The patient complained of a sore throat, difficulty swallowing, and a feeling of something in his neck, and this is what made his verbal responses difficult. Again, a few potential diagnoses came to my mind, some more likely than others, like pharyngitis, tonsillitis, or even an enlarged thyroid gland. He did report that he was suffering from a lot of pain, and that other members of his family were previously ill. After about ten minutes of questioning, I performed a similar exam as I had performed on my first patient, examining this patient’s throat, lymph nodes, nose, and sinuses. He winced as I put pressure on several of his lymph nodes, another sign of pharyngitis, which eventually became my ultimate diagnosis. I felt that this second encounter went more smoothly relative to my first encounter, at least the fluidity of questioning and physical exam techniques (the earpieces decided to cooperate with me this time too!). And so, within forty minutes, I had questioned, examined, and diagnosed two patients. It was my first attempt at what I will likely be doing every day for the rest of my life…and I loved it.
After each encounter, we received feedback from the patients, as usual. The only critique that my first patient reported pertained to my management of time. The allotted appointment time for each encounter was twenty minutes, but I finished about six or seven minutes early with my first encounter, and the patient felt that I might have thought of additional questions to ask him had I stayed those extra minutes. The second patient’s main critique focused on my note taking during the interview. He recommended that, when taking notes, I should angle the clipboard upward and more towards me, such that the patient doesn’t focus on my moving pen or the notes that I am jotting down. Overall, this was an amazing experience, yet again, and I love the feedback that these standardized patients give. I guess just as I once learned how to ride a two-wheeled bike, I’ll eventually become increasingly more comfortable and confident with patient encounters.
Question of the week: True or false: Warfarin promotes blood clotting.
My midterms are finally over (though I have my Cardiology and Pulmonology finals over the next two weeks)! How did you do on your midterm?
Last week’s answers: Three times a day; False (an otoscope); True; Pancreas; A medical setting; The ABCDE rule; An otoscope; 20/15, 20/20, 20/200; Lungs; Electrocardiography