Last night, over the period of three hours, we went through the last OSCE, a clinical skills examination involving a scenario with a simulated patient.
As usual, I began quite nervous with butterflies fluttering in my stomach. From station to station, I became more confident and more relaxed, as the differential and the questions flowed through more easily through my mind.
At my last station, I was met with a scenario I had never encountered before in practice. I struggled at the door, scratching my head as I read the scenario. The bell rang and, without any solid grasp of what I wanted to ask or what physical exams I needed to perform to find the cause, I went in.
My struggle was obvious. I had elicited a passable history that helped to point me in the right direction; however, my focused physical yielded no findings. I was stuck.
I paused for a moment, and excused myself as I gathered my thoughts. Ding. One minute remaining. Think Tom. Think! Hastily I added a few extra tests. Again, no findings. Ding. Your exam is now over.
I looked to the doctor marking me, whose eyes asked with disappointment: did you study this topic at all?
No. I guess I probably should.
It was an unusually busy shift in the emergency department. There was no time to rest, no time to sit, and no time to catch our collective breath. The patients kept coming and the wait list kept growing.
Between me and the only physician on the ward, we were heavily outpaced and outmatched to meet demands. The teachings were suspended as I helped deal with the easier cases as my attending tended to the sicker patients.
As the clock struck noon, we finally had another doctor on site to help us with the growing stack of charts. Tensions eased. We could finally go for a break.
In those few short hours, I had seen a few fractures, dislocations, diabetic crises, electrolyte disturbances, chest pains, and acute abdomens. I had an opportunity to insert foley catheters, reduce shoulders, intubate a trauma patient and assist with a central line.
It was a concentrated shift of experience.
“You earned your stripes today, kid,” said the exhausted doctor as our shift together came to an end. “Go home and get some rest.”
It is not about the biological therapies we give patients. It is not about the medicine. At the end of the day, it is about the relationship you forge with your patient and the trust and understanding that comes with that that dictates their compliance and willingness to continue.