Patient History

So last Friday, things got real. This is, of course, an overstatement, because as a first year medical student, the misnomer "real" simply implies that the activity is modeled after the "real" thing, "real" here being clinical rotation.

[A brief aside: There are a lot of extraneous words in medicine. To excel at most of these courses, you need to understand how the English language, and its romantic predecessor, work. You also need to know an astronomically huge number of words. During the briefing for anatomy we were told we'd learn 5,000-7,000 new terms just by cutting apart the human body--which I guarantee you is a finite object. Today I found myself looking up terms during our embryology lecture. I believe I have an intermediate grasp of vocabulary. But when I had to look up "occlude", I felt like an idiot. At least when I leave medical school, I won't feel embarrassed pursuing conversation with my peers, intellectuals who went on to pursue graduate studies in English, at cocktail parties: Oh yes, I feel like this 1999 Cabernet Sauvignon is occluding the citric taste of these gourmet Chipwiches. Closing aside: What is the exact definition of clinical rotation?]

The session I had on Friday was an introductory lesson on how to take down a complete patient history, including chief complaint. I was observed on a computer screen by my partner, taking brief notes, in another room. I was judged on several metrics, and I knew this as I sat across from someone and talked to them about their health. The whole thing was fake because the patient was standardized. There are actually professional patients. The pain they explain is not actually real. Their names and their lives are fictitious. But they are "technically" alive, and this is where it got tricky for me.

I love doctor-patient communication. I find communication fascinating. And it's important. Learning how to say the right thing is sometimes more important than knowing what the right thing is. I firmly believe I have a handle on the way doctors and patients should interact. I wrote a thesis on the topic, and I am convinced my final solution, crafted out on pages thirty-eight through forty-two, would work wonders for the field of primary care... if we lived in a theoretical world. Unfortunately, undergraduate institutions love idealizing things. Everything seems more "right" or "wrong", "effective" or "useless" when you're reading hundreds of papers and looking at statistics and analyzing everything from a safe distance.

Put me face to face with an actual human being, who is alive, and I no longer care that I am supposed to ask them about their lives or that I need to know the exact quality of their pain. I no longer know that perhaps the way I speak is too fast, too convoluted... nonsensical. I'm palpitating just thinking about it.

If the professional patient/actor had been a robot, with non-judgmental eyes, maybe I would have calmly proceeded to ask it a lot of seemingly irrelevant but pertinent questions. Maybe I would have done well. But I wanted to become a human doctor. Serves me right. I shook the entire time. I started sentences I was unsure how to finish. I never did get around to asking questions about family history. My notes are a jumbled mess.

I wonder in what situations meeting someone for the first time won't be nerve-racking. Will that time occur when I'm a full-fledged doctor and my status crushes fear? Or will it always be stressful trying to think with a first time patient why they feel as bad as they do.

My professional patient said I did a good job of sounding coherent and making eye contact, but I know that's not good enough. She said I needed to do a better job of setting up an agenda from the get go. I wonder what's the best way to do that?

So right now I am putting my theories on hold. The funny thing is, all this dread and apprehension was caused by a clinical setting that was highly controlled and entirely fake. The real world is waiting for me, not too far away. Real patients. Real problems. Real communication issues. Now that's terrifying.