Friday, September 16, 2011

First "patient" interview

On Wednesday I took my first "history" as a "doctor." (Look at all those quotation marks!)

Our clinical skills class began a new phase this week. We have finished learning the history and review of symptoms--now we get to practice! Each week, a student will interview a "patient" with a chief complain related to one of the systems in the ROS. This week was "breathing problems," and I volunteered to do the interview.

Before class, I'd emailed the professor: "I am looking forward to practicing history-taking on Wednesday. Will I be responsible for taking notes during the interview? Also, will I go through the ROS and complete family/social history?" The response was typically crisp and without all the capitalization I'd bothered with: "no notes mostly the general and resp ROS questions so you can do the HPI for this case of breathing problems...thanks for volunteering..." (I didn't add the ellipses: that was the exact text of our emails. Maybe someday I'll send emails that surgical.)

The nights before, I reviewed the ROS and practiced questions to myself. "When do you cough? How long does a cough last? Do you cough anything up? How much?" It was so exciting!

Then, right before class, the professor beckoned me to the front of the room and ran a finger over the respiratory ROS, talking me through things. He told me that he will involve the rest of the class in the interview, and that he would interject frequently. I was half glad (yay! I wouldn't be stranded!) and half sad (darn...I wouldn't get to show off...) about this; the smart part of me glad and the stupid part, sad.

The first part of class was a thirty-minute of overview of the most common respiratory problems that bring people to the doctor (allergies, viruses, bacterial infections...). I saw the "patient" sitting at the front of the room. I didn't know whether he was an actor or an actual patient/volunteer. He looked about fiftyish, had mousy-brown thinning hair, and wore round thickish glasses. He sat quietly; I wondered if he knew I was observing him, and I wondered whether he knew I was the one he'd be talking with. Then, I was called to the front of the room.

I had to wear a microphone to be heard in the lecture hall by my 122 peers. Just as I sat down and began, the professor muttered, "'scuse me a moment." Then I heard the sound of the door shutting behind me, and a few titters from the audience. I had the distinct feeling of being the subject of a bait-and-switch. I was now alone at the front of a huge room with this patient.

But the patient looked so gentle that I wasn't too afraid. I had plenty of questions to start with, and the stupid part of me (the one that wanted to show off!) felt pleased. I started asking questions (flopped a little on open-ended ones to make the patient decribe the chief complaint) and proceeded through most of the HPI with little interruption in flow.

Then I sorta ran out of questions, and still no appearance from the professor! I stalled, silent...then I looked at my classmates. "I hear lots of whisperings," I said aloud, scanning the seats. Someone called out, "what about smoking?" and someone else asked, "where do you work?" The interview sputtered on for a few more minutes like this...where was the professor? (After class ended, he informed me that he'd felt sort of faith and stepped out to get a juice from the vending machine.)

I heard the sound of the door opening and I turned toward it hopefully (I tried to turn slowly, as though I was not desperate). Hurray! It was the professor! He sat down again and asked me how far I'd gone. Satisfied, he began to engage the class, asking us for differential diagnosis. I was allowed to sit down.

THEN, the professor reintroduced the patient. "This is Dr. _____, a colleague of mine," he said, "and he'll now give a brief presentation on asthma." I felt much like I had when I found I'd drawn blood on a doctor in the hospital once. A doctor? Oy vey. But Dr. ____ seemed pleased with a few things I'd done, though, such as ask follow-up questions.

One down, a trillion yet to enjoy.

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