Now in no way do I mean to offend anyone with breasts or any breast connoisseurs, but they sure made my first physical exam a little more difficult. Friday was our first standardized patient interview, and while my patient was no Kramer, I couldn’t help but feel nervous. Not only had I never tried to do a full history on a stranger, let alone a physical, but I’d never tried it on a member of the opposite sex.
We had 20 minutes to complete a focused history and do 3 parts of the physical exam–heart, lungs, and abdomen. Time goes much faster than I expected–it felt like the history was a quick five minutes, leaving me to somehow stretch the physical out to at least 10–but it ended up working out fine. I tried making conversation, and I think it went well, but I think I must’ve been flush red the entire time. I was sweating like mad. The patient was complaining of “chest pain,” but she ended up pointing more toward her abdomen. She said it was a burning pain that radiated up to her esophagus, and worse with coffee and alcohol. Myself being a heartburn sufferer, I was pretty sure I had my diagnosis (even though that wasn’t the point of the exercise). After the history was complete, I moved onto the physical exam. I had a quick introductory session to “patient gowns” and “draping” before the exercise, and tried to do my best. Listened to the lungs and such, then moved over to the chest. I nervously, but non-chalantly tried to explain to the patient that I’d be examinining her heart, and went for it. Conclusion? Breasts make it much harder to find the heart apex. I just kind of lifted the breast with one hand, using the patient’s gown, and tried to listen, but couldn’t find it. Tried again. Couldn’t hear a thing.
I guess practice makes perfect.
My preceptor and I reviewed my tape, and he said I did well, but I cannot stand seeing myself on television. No one can. I walked into the room completely awkward, shoulders clenched. We had a list of “things I did well,” and “things I can improve,” and it’s just much easier to find things you did poorly. Drop the shoulders! Look at the patient more! Quit saying okay so much! Awkward, awkward, awkward.
It’s kind of a weird ending to the session, because you don’t know enough to truly diagnose anything, so you generally make up some sort of fake conclusion, like, “Okay, I’m going to go report this back to the attending so we can figure out what’s causing you this pain.” Or, as my friend Melissa told the patient, “Well, good luck with that cough!”