A Day of Firsts

Today was a pretty neat day. After six weeks of mostly class with the odd small group discussion thrown in to keep us on our toes, we finally got to do something today that almost felt like really learning how to be a doctor. From now on, Fridays are Clinical Methods (or, in Western slang, since nothing can be spoken or spelled in full, ClinMeth). For today and the forseeable future that basically means a small group of people interviewing standardized patients.

A standardized patient, for those of you keeping track, is essentially a person who is to act like a patient coming into a doctor's office, with a set of symptoms, family history, etc. Our job is to have one person interviewing the person while the rest of the group waits in the wings, watching. Things get more fun when the person interviewing gets stuck and they call time out. At this point, the "patient" sits and pretends not to hear while we talk about how the interviewer is doing, what they could ask, what they might have done better, and so forth.

Now although I didn't actually do the interview today, it was neat just to be part of the experience. And of course, I'll get my turn soon enough. Interviewing is a bit of a tricky thing. You need to be open enough in your questioning to let the person feel involved, specific enough to get the information you need, personable enough to make the patient feel at ease. For the time being, with our lack of knowledge of disease, it falls to us to work on the third, while dabbling in the first two to get a sense of how it should work.

Apparently, when med school students start out they're all great at being "patient centered," and we all end up impersonal and jaded by the time we make it through clerkship and residency. Probably due to the long hours and frustration with the heirarchy of power we have to claw our way up. For all we're told about the phenomenon, it certainly seems a long ways off right now. Hopefully we as a class can maintain the level of humanity and "patient centeredness" we have now.

The second neat thing about today was my first cadaveric dissection. Though the prospect of this is something that would turn some people's stomachs, I was quite intrigued by the whole thing. Despite the fact that our cadaver didn't have a radial artery that we could locate (no small feat - no blood to half her arm) the rest of the work went reasonably well. Things are never as clear cut as they are in your nice textbook pictures, but our work on the flexors of the forearm (think moving your wrist toward your elbow) allowed us to separate and identify most of the things we were supposed to find.

The real trick will be when we have our bellringer test and I have to be able to identify pretty much any structure they pick in the upper limb... but that's a story for another day.