Wednesday, February 27, 2008

Today, in clerkship, my preceptor, a peds gastroenterologist, was running behind, so he threw a chart at me and told me to go in there and talk to the patient. The chart was completely empty except for a photocopy of their insurance card.

So I did my first Real Medical Interview today. For about half an hour. Completely unrealistic to have that kind of time, I know, but I got a ridiculously detailed history involving a rather dramatic family dynamic playing into the medical condition. Really, it was almost novelistic.

It was a little frightening, I admit. With less than a year of medical school under my belt, I have no clue what sorts of questions I need to ask. "So, what brings you here?" was my opening gambit. We rehashed the same topics over and over as I racked my brains for the best thing to say. At one point, the mother asked me, point-blank, for a diagnosis.

"Well," I demurred, "I'm just a medical student, so I can't tell you much."

"Oh." The corners of her mouth turned down. I felt terrible for not having an answer.

So I said, "I just learned about how sometimes, there might be a sort of block between the colon and the brain. Like the nerve cells in your intestine don't work properly, so your brain can't sense when to go to the bathroom. That might be something you could ask the doctor about when he comes in."

Very confident, as you can see.

Then I felt even worse, because I had no clue what I was talking about. All I know about GI, after three weeks in the block, are celiac sprue, Hirschsprung's, and cholera. Oh, and situs inversus. Everyone has situs inversus.

Luckily for me, the doc arrived; I fumbled my way through the presentation (first presentation as well!); and when he went in, his explanation also involved damage to the vagus nerve. So I didn't completely mislead the mother.

In short, my faith and interest in medicine are renewed once again. Thank God for clerkship.


Graham said...

Here's my opening bit--keeps the patient's expectations in line:

Hi, I'm Graham, I'm the medical student who's working with Dr. Jones today. I'm going to talk to you, examine you, try to figure out what's going on, and then I'll come back with Dr. Jones and we'll all talk together. Okay?

So, what brings you in today?

The Scrivener said...

Good tip. I did introduce myself as a first-year medical student, but next time I'll make sure my role is more clear. Sometimes I think people don't hear the words and just get fixated on the white coat.