It's Not Routine

I remember the first physical exam I did on a patient like it was yesterday. My professor and I, along with 5 other medical students stepped into a ward that was full of volunteer patients (patients who volunteered for the sake of education to allow themselves to be subjects for 2nd year medical students). We walked up an elderly patient and my professor said "Dr. Angel will be examining you right now". The patient sat upright on the bed and faced us.

The professor said "Proceed".

I stepped up to the bed, introduced myself as we had been taught in physical diagnosis and fumbled thru my medical bag for my pen light, opthalmoscope, and a tongue depressor. My hands nervously palpated and I could feel the sweat dripping down my back as the professor maked/wrote evaluations on her clipboard, coughed nervously and sneered a couple times. My fellow classmates hid behind one another in hopes that the professor wouldn't see them or call them up to plate next.

I apologized everytime the patient winced when I would palpate a tender part of the abdomen. I asked when the pain had started, the duration and what exacerbated it or made it better. To take the patients mind off what I was doing, I asked about family members, when they see their loved ones next and television shows they missed while being holed up in the ward.

When we were finished, the patient smiled somewhat and said "I think my blood pressure may have raised because you made me nervous. It isn't a reflection of my regular readings. Please be sure to mark that in your history".

I said "Excuse me? I made you nervous? I'm sorry, I didn't mean to make you uncomfortable. I hope I didn't do anything wrong and I apologize for the inconvenience".

The patient then said "You didn't do anything wrong, but you were just so nervous, I thought maybe you knew something I didn't and it made me nervous to think that you were searching for something they hadn't found or were trying to confirm".

I apologized again and said "I'm still a student".

The patient said, "It's okay. I'll still be your patient. I'll see you later doctor".

"Oh, I'm not a doctor, I'm a second year medical student", I reiterated.

The patient laid back onto the bed and said "You're a doctor. It was in your smile".

When I walked out of the room, I realized that sometimes as physicians we can evoke certain emotions from patients, by body language, facial expression and other non-verbal statements we make. Over time I mastered how to do a complete exam in less than 10 minutes, when it use to take me close to 45 to do a P.E. and interview. I learned to examine while interviewing and to pull necessary information by wording my questions in a way to get the right answers.

I hope I learned the art of bedside manner--the most important part of being a physician. I'm still learning cause I know that each patient personally has more to teach me, then any malady they may have.

I think that patient comfort and the kindness and compassion they receive from us is vitally important.It should be incomporated into the routine.