Reality Strikes: A Doctor-In-Training Encounters Her First Patient

It's never too soon for medical students to have their first patient encounter

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Being a first-semester medical student feels a little like playing a doctor on TV. There are lines to memorize: we say “axillae” instead of “armpits” now, and “epistaxis” instead of “bloody nose.” There are props: the stethoscopes, engraved with our names, that we tote around but have yet to use to examine a patient. And of course, wardrobe: the short white coat that to me still feels a bit like a costume.

Some of the first “patients” we see are, in fact, professional actors, trained to mimic the symptoms of a seizure disorder or the aftermath of a suicide attempt. And we do some acting of our own, particularly when patients know more about their symptoms than we have yet to learn: “My IgE is off the charts,” one man told me as I shadowed his doctor during his visit. I frowned and nodded, showing no sign that the clinical significance of this fact was a mystery to me. (I looked it up later.)

So I was eager to move on to the real thing. I took a medical history recently for the first time–from a young Indian-American woman just a few years older than I am–and a real patient. But the fact that I was no longer playing a part didn’t hit me until later.

“What brings you here today?” I asked. A painful lump in her armpit, she said. Two weeks earlier, the doctor had examined it and determined that it was probably nothing to worry about, but had asked her to return for followup.

Running through a mnemonic in my head, I walked the woman through the major questions necessary to flesh out the chief complaint and history of present illness, the components our professors had tasked us with eliciting that week. (OPQRST, the memory trick for pain goes: Onset. Provocation/Palliation. Quality. Radiation. Severity/Symptoms. Time.) I didn’t interrupt the patient; I spent time with her; I even made her chuckle. I listened to what she said and wrote it down.

Afterwards, my supervising doctor took over, asking the woman to lie down on her back. Palpating both sides of the patient’s chest, she asked where it hurt. At first, as the doctor pressed, the patient looked confused. Then her face brightened. She started pressing on her own armpit, looking down and then back at the doctor. “There’s just some tenderness,” she said. The pain had gone, and there was no lump. What she thought was a cancer scare was no longer. The temporary pain, and the lump, had gone away on its own. Whether it had arisen from too much salt intake, too much caffeine or something else entirely, it wasn’t cancer. We three parted ways, shaking hands, all smiles.

As for the interview, I had, the doctor said later, “done great.”

A few hours later, I left the office on something like a post-performance high. As a former journalist, I had conducted hundreds of interviews before. But this was my first as a student doctor. Pulling out my phone, I sent a proud medical student email to my whole family: “I took my first medical history!” I wrote, adding that it had gone well and that it had even related to breast cancer–a subject we were studying in class that week. I practically bounced down the street.

Only when I got back to my room and hung up my coat that evening did it sink in: the young woman I’d met today was not an actor. She was not one of my classmates, pretending to be a patient and rattling off symptoms so that I could practice taking a history. She was real. She was the kind of person that I will be able to take care of, years of study from now, when I am a real doctor. Just then she might have been hanging up her own coat, with a bounce in her step for a reason completely different from mine: she didn’t have cancer. This was the true joy of the day. And for a few moments neither of us will ever forget, I got to share in it.

1 comments
hs.seeker
hs.seeker like.author.displayName 1 Like

Hey, almost-a-doctor! Good job. And you have made a crucial discovery, one that so many "physicians" never make: these are real people you're "practicing" on. Despite all their faults, they are part of you and your job will soon be to take care of them to the best of your ability. Congratulations on making this realization so early in your career. I salute you and applaud you. I also wish you the very best.

For the record, I was a combat medic in Vietnam and a Paramedic in Kansas City and other places and now work in the ICU of a hospital in Wichita, Kansas. I have seen more than my share of arrogant, elitist, uncaring physicians. It is such a refreshing feeling to read of someone like you. May you never forget.

Dave Keith