Hi Tom! “Your histories and physicals are impeccable… ” Congratulations! Any advice on how to get there? As a medical student who has just started bedside clinics, I find them challenging. Thank you! :-)
I do not think I will ever shake that feeling of being a student doctor. The learning never stops. For the basic clinical skills like doing physicals and taking vitals, I became more comfortable with practice and repetition. Now, I am at a point where I am comfortable enough to be thorough, put some of the pieces together, and figure out a basic differential based on the findings. For many other advanced skills that I have not had much exposure to, I still feel as lost as I did when I first learned the basic skills. To feel truly qualified is going to take more practice and experience.
Do not forget the DRE.
I did do a pelvic exam with a GTA and it was a very unique and very helpful experience. There were a couple of GTAs, and with them we went through various maneuvers and different exams, like the Pap smear and the bimanual. I really appreciated and respected their presence and willingness to go through those very private and intimate exams with us. The feedback from that experience was invaluable. Though we only went through the exams once, I definitely feel a little more comfortable with performing them now.
As the eight of us crammed into the examining room, the doctor quickly greeted the volunteer patient, an old acquaintance. The elderly woman had been waiting in the room patiently as we discussed the clinical finding and examination techniques for skin lesions next door. She had a book in her lap, and quickly set it aside as we all shuffled into the room.
"Everyone, this is JS. She will be our subject today." She sat still in her chair, looking at us pleasantly.
"We will do this one at a time. Come up here, feel, and describe your findings," the doctor said in a soft voice. He looked to the student closest to him, and ushered him closer, pointing at a particular lesion on her arm. He quickly went to work trying to identify it.
"It feels flat…small diameter…so a macule…" and on he went. Still, the patient sat, motionless as this stranger felt and scratched at the mark on her arm.
For a moment, she looked at him, smiling. However, realizing that he was too invested in his findings to respond, she quickly looked elsewhere. I observed as she tried to get back to her book but unable to keep the pages open with only one hand, she abandoned the idea and decided to sit and wait as we all took our turn.
By the third student examining a lesion close to her forehead, she was visibly bored. Still, no one had addressed her. Not even a hello.
It was my turn next, and even as the doctor tried to point out a lesion for me to identify, I quickly leaned in to shake her hand: “Hi, my name is Tom.” She sat up in her seat and beamed at me: “Nice to meet you, I’m J.”
It was a simple gesture, one that took less than five seconds to do. The interaction was humanizing, and put a patient that was otherwise not engaged in the situation at ease. A simple recognition is sometimes all that separates a good encounter from a great encounter.
As I move forward into my clinical years, as I see more patients in my life, it is important for me to recognize the person behind every encounter, behind every chart, behind every diagnosis. It all begins with the words: “Hello, my name is…”