After three days of orientation, eyes constantly aglaze from seemingly endless “seminars” and “introductions” (I think we even had an introduction to our introduction), perhaps I can be forgiven for not having prepared in any way for our next day. Our schedule simply read: “Standardized Patients” – for which an entire afternoon was reserved.
To those of us who have spent inordinate amounts of time in the world of medical training, the phrase ‘Standardized Patients’ has a familiar ring to it. It’s a term for any of a host of pretend patients; sometimes professional actors, sometimes regular people, sometimes even manikins. Part of the USMLE is a test using paid, pro actors who pretend to have various ailments which we hopeful doctors-to-be nervously attempt to “help”.
Feeling experienced and savvy in the Standardized Patient world, I figured my schedule was going to be an afternoon pretending to be a doctor for people pretending to be sick, and then we could all generally pretend I was the greatest healer of ailing humanity on pretend planet earth.
Late, but still doggedly ambivalent, I rushed into the meeting room where we are being told how the day will progress. As some lady talked urgently, I was thinking, “Wow, they’re sure taking this thing SERIOUSLY. They act like I’ll actually be doing something today…dude, whatever. Get over yourselves.”
Turns out I was only half-right. The first patient of the day was, in fact, pretend. Unfortunately for me, the second was real. She was a newly pregnant 20 year old who had never had a baby before. “You’re her doctor.” I was told by someone as we were rushed to the exam rooms. Some other person I’d never met in a white coat hurriedly crammed some papers in my hand. “That’s her medical history…it’s long,” was all she said as she vanished into a different exam room. I glanced haplessly at the inch-thick stack of papers in my hands.
I pulled one of the other new residents aside, “Ian, this is FOR REAL?” I asked.
“Yeah, and she’s an OB patient, so you gotta do a pelvic, a breast exam, a pap smear, cervical cultures, dopplers to find the baby’s heartbeat and whatever else she needs. Have you done much of that in school?”
“Well, through med school I decided P-A-P stood for “Places to Avoid if Possible.”
“Ohhh, you’re SO bummed now,” was his sympathetic response.
Truthfully, since my med school was in Israel, many of the women we saw were orthodox Jews or traditional Bedouin and they had no interest in helping out some male medical student waving a speculum around and wondering which end was “in”. Not that I can blame a woman of ANY persuasion for being less than accommodating in this regard.
“I don’t think I’ve ever actually done one of these,” I lamented with insecure hand wringing.
But my friend was gone, already pulled into his exam room.
Before I could think much more about my predicament, I was herded into the patients room. A 3rd year resident was there to observe me, but gave no direction. My tie was on sideways and one shoe was untied. My white coat – newly bestowed upon me by the residency program with my name embroidered on it – scrunched my shirt collar down because I threw it on so quickly; the tag sticking up out of the back. I’d glanced at the patient‘s chart and history only long enough to get confused by it. All I really saw was a long list of medications with names that only vaguely rang familiar from med school. I didn’t even know her blood pressure. Heck, what’s this girl’s name, anyway?
“Hi, I’m “doctor” Ankeney.” I try to say with some sort of confidence. As I’m standing there looking as in control as possible, my stethoscope, hastily crammed into one of the pockets of my white coat, had partially sprung out of its confines; the main tube now bouncing wildly in the air. “How can I, uh, I guess help you, today?”
“You wanna hear my list of problems?” she says. “Yep. I’m ready.” I say, realizing I have no pen.
“I’ve got urine leaking out of my vagina. I’ve been bleeding off and on since I became pregnant with this baby 12 weeks ago, and I’ve been to the ER 6 times for it. I have diabetes and I’m on insulin and pills for it. I have gall stones that might lead to my gall bladder exploding, and I’m pretty sure I might have a sexually transmitted disease. I have depression, and I’m told that the meds I take aren’t good for pregnant women but I’m afraid I’ll become suicidal again if I stop them. Oh, and I’ve have had 3 miscarriages for no reason, and I’m desperate to not lose this baby. What are you gonna do, doc?”
“Absolutely nothing. Good luck, lady.” I think whimsically.
My actual response was more eloquent and sensitive,
“Uhhhhhhh. Wow, that’s too bad.”
After a few more minutes of uncomfortable fumbling, I finally managed to ask her some doctor-sounding questions, and we did make some progress. The 3rd year resident even deigned to loan me her pen. And
I did get competent help on the pelvic, so the poor girl didn’t suffer too much (I hope). As for her other problems, I was able to help her where I could and a faculty member came in to help me with the things I couldn’t handle. Later, I was given a sort of tepid apology from one of the faculty, “She was a little more complicated than we usually start you guys with,” she said.
Uh huh. Thanks for that.
The residency is designed for me to follow patients like this throughout their pregnancy and even through the 3 years of my training. Since I’m just getting started, this clinical work only happens one morning per week for half a day and the rest of the time I’m in the hospital. For that reason, I haven’t been able to see this first patient of “mine’ again. Lucky her. She probably marched straight from the office to the nearest lawyer.
Still, I often wonder how she is doing. I’m told she was handed off to one of the senior residents because she is so complicated. I hope she has been able to keep her baby so far. And I hope whoever her new doctor is at least has a pen.
