The History and Physical
Every so often, doctors like to pull medical students into patient rooms and force them to demonstrate their clinical skills in action. The love this. They relish it. Their favorite thing of all is to base your final grade on your performance in this contrived student-patient interaction that is known affectionately as The History and Physical. Or "H and P" for short.
Yesterday i had my observed H and P. My attending, who evaluates me but does not work with me on a daily basis, met me outside of the room of a patient who i had never met before and knew nothing about. She then observed me as I took a full medical history from this poor unsuspecting patient and then submitted them to a complete physical exam. I then gave a 10 minute presentation on the patient I had just seen, including the relevant portions of the history and exam, complete with my assessment of their various medical problems and my plans for addressing them.
This, needless to say, was a little bit nerve-wracking.
It did go pretty well, though, and by now I'm used to these sort of interactions with patients so it wasn't all that stressful once it got rolling. My attending had a lot of positive feedback, which was nice. But she also, as expected, had some constructive criticism, which i will share with you now.
1. "When you go in to talk with a patient, turn their TV off." I was well into my exam when i realized that throughout my entire interaction with this patient she had been watching the soap opera Passions on mute. I thought she was just concentrating on my astute questions.
2. "Always examine from the patient's right side." If you are right-handed, this allows for the best maneuverability. Good to know.
3. "Streamline your exam technique." I honestly took the patient's socks off three times during my exam. Three different times! I'm going to look at your feet now... oooh now I think I will check sensation... wait, maybe i should just check a Babinski reflex real quick, sorry... It was pretty bad.
4. "When you are asking a patient with emphysema to take lots of deep breaths, maybe you could stop and make sure they are breathing ok." Hmmm. Good point.
There were also tons of obvious questions I forgot to ask, and tons of little things that I forgot to do. Moral is, when people are watching you, and especially if the people who are watching you are also grading you, you will inevitably do dumb things. It is statistically impossible for something to not go wrong in such a situation.
Tomorrow is the last day of this 5-week internal medicine rotation. I have my final evaluation session with my attending at 9:15. And then i just hold my breath until the next 5-week internal medicine rotation starts. I would be lying if I said this wasn't getting a little old.
I watched four episodes of Grey's Anatomy last night and thought of you. Here are some things that I wondered: 1) Do you wear cute contrating longsleeved t-shirts under your scrubs a la every woman on Grey's Anatomy? 2) Do people really have sex in those nap rooms? BE HONEST. 3) If you were on Grey's Anatomy, who would you date? I feel like the obvious answer is the Patrick Dempsey character for obvious hotness and greying hair, but I honesely think I'm getting into George.
1) In the real world, almost nobody wears longsleeve shirts under their scrubs, even though admittedly it does look very cute. For one, if you are a surgeon, you put on a sterile longsleeved gown in the OR, and you would get too hot. For two, you usually wear your white coat when you are seeing patients, as it has enough pockets to keep all your stuff in. In the show Scrubs they also sport the long-sleeve-under-scrub top look as internal medicine residents. In my experience, medicine residents always wear professional clothes with white coats, and never scrubs. It is considered too casual.
Did you know that most of these doctor shows design their own cute, snug-fitting, shorter-sleeve scrubs - because real scrubs are in reality very unflattering? Its true.
2) I have never heard of anyone having sex in a call room. It probably has happened, but there are several prohibitive factors: usually these rooms are shared with other people, and you never know when someone will walk in. Also, there usually aren't that many single, attractive young residents in any given program. The horniness factor is MUCH exaggerated on tv. Plus, if you find yourself on overnight call, you are typically very exhausted and sleep-deprived and it would be a more productive use of time to just sleep. Wow, that was a depressing statement.
3) You know, Patrick Dempsey doesn't quite do it for me. Is George the nice, bumbly, scared one? Him. Though he might be a bit short for me.
Fiona, do you find that the grades (if that is the right term) you receive for exercises such as the H&P sometimes seem subjective and arbitrary? At your school, are there black-and-white benchmarks for performing a successful H&P that don't depend on the grader's own personal preferences?
I have heard comments from non IM residents that their evaluations seem to be very subjective and lack correlation with evaluations from others attendings. Some attendings may write radically different evaluations dependent upon the time at which they write them, and they may not correlate at all with other attendings evaluations. These evaluations are written for a period of time and not a single procedure or H&P. The resident may not weigh certian feedback as strongly because they feel that a particular is merely difficult and is not consistent. They just keep trying to the best job they can and work on their weaknesses.
It seems strange, then, that obtaining a high mark on a rotation is so important if you hope to get a residency in that particular practice area.
Fiona,
Don't lie, every bit of Grey's Anatomy is factual and based on true stories of life between real patients and their real (ly good looking) doctors. Locker rooms are always co-ed. In fact, residents hang out topless during most of their free time. Clothes inhibit the creativity necessary for a good SOAP note. Scrubs on the otherhand is not 100% accurate. I have never personally hit golf balls from the roof of the VA. They should do their homework. Happy Birthday Dr. Garlich.