Week 29: The Final Stretch

          Note: The “patients” I speak of are actors/actresses hired and trained to simulate real patient encounters. 

          Today, at 11:15 a.m., I found myself standing in front of examination room #9, the same room that stood before me not so long ago. When given the cue to knock on the exam room door and meet my first of two patients for the day, I would once again cast my PA school training wheels aside. When prompted, I knocked on the door, entered the room, and found my first patient, a short, older female sitting a bit hunched forward on the exam table. After a brief introduction, I asked the patient what brought her to the office today, and she answered that she had been experiencing left abdominal pain for about two weeks. As I elicited the history of this complaint, it became clear that the patient was a bit nervous about the possibility of colon cancer, being that her mother had passed of this diagnosis several years ago. After much questioning, I proceeded with an exam of the patient’s abdomen, and so I listened to her bowel sounds, assessed the size of her liver and spleen, and palpated (touched) several abdominal areas, including the area of pain. The patient noticeably flinched when I placed pressure on her lower left abdomen, the site of pain, but this was an expected reaction. When I completed the exam, I inquired about screening tests (specifically colonoscopies) that the patient had in the past, and she reported that her last colonoscopy showed signs of diverticulosis (formation of pouch-like structures in the colon). This colonoscopy finding fit well with my overall impression, and so it was most likely that the patient was experiencing a bout of diverticulitis (inflammation of one or more of these pouches). Being that she did have a fever, I reassured her that her discomfort was likely due to this (diverticulitis), rather than a structural abnormality like colon cancer, but I did recommend another colonoscopy so that we can be certain of the diagnosis. The patient seemed content with the plan, and with that, my first twenty-minute appointment was complete.

          At 11:45 a.m., I knocked on the door of exam room #10, and entered to find my second patient, a middle-aged man, sitting upright on the exam table. Once again, I questioned the reason for this patient’s seeking medical care, and he reported that he has been experiencing episodes of wheezing and overall difficulty breathing when he vigorously exercises. The first diagnosis that immediately came to mind was exercise-induced asthma (narrowing of the airways provoked by exercise), and so I focused my history questioning accordingly. After eliciting a thorough history of the complaint, I proceeded to perform a lung exam on the patient, in addition to a cardiovascular exam (these two systems always go hand-in-hand, so I listened to his heart just to be safe). This patient’s main concern was that he would have to stop exercising forever, and since exercising was one of his favorite stress-relievers, this prospect was a bit depressing for him. Again, I tried to reassure him as much as possible, and explained some of the options available for him if he were to be diagnosed with exercise-induced asthma after further testing. I also stressed that he would likely not have to completely eliminate his daily exercise regimen, but would more likely just have to modify his exercise habits. This seemed to comfort him, and with that, I completed my second appointment of the day.

          After six patient encounters (two last semester and four this semester), I definitely feel that I have come a long way in my interviewing techniques. I feel my nerves before and during each encounter dissipating a bit, and I find myself being more fluid with my interview techniques. Yes, there are questions that I always need answers to, and so structuring the interview is important, but I find that what works best is allowing the patient to guide the order of the interview, and this really is what allows him or her to narrate his or her own story. I won’t have another standardized patient encounter until next semester, but I know that I’ll never forget the feedback and knowledge acquired from these first-year encounters.

          With fourteen weeks behind me, only one week remains until I complete my second semester (and first year!) of PA school…well two weeks. Like last semester, the school mandates a “study week” between the last week of classes and finals week, so next week just serves as a make-up week for us. So, the next time I post will be two weeks from now (I’ll be the happiest person alive in two weeks). Six finals stand in my way of a three-month bout of freedom. I remember saying this last semester at a similar time, but I wish we could flash-forward to May 15th

While I wrap up this semester with all of my finals, good luck on your final:

1. Vitamin K combats the action of warfarin. So, true or false: Vitamin K promotes blood clotting.

2. The kidneys are composed of microscopic components called _________.

3. The heart valve located between the right atrium and right ventricle is the __________ valve.

4. Your patient is experiencing flank pain, which you attribute to the presence of a kidney stone. What is one procedure that may be used in the treatment of this patient’s stone?

5. True or false: Prednisone is an antibiotic.

Last week’s answer: Furosemide (Lasix) is a diuretic. 

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