Shaken Not Stirred

Monday, May 08, 2006

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.

28 Comments:

  • There is undoubtedly an art to the H&P and I think you've nailed it.

    No matter what a person says, nonverbal communication conveys more than the actual words... what it actually communicates, however, can definitely be misinterpreted.

    Compassion, communication, and caring are the keys to contact between healthcare professionals and patients because these instill a degree of trust, which is necessary in all patient care... I don't think you'll have a problem in these areas.

    By Blogger Tea and Books, etc, at 1:07 AM  

  • Comp. agree Angel

    The Doc's attitude makes a world of difference.

    When I was having problems w/ my tonsils, I had a doc that actually made me laugh through

    Draining puss out of my moulth...yowsa~! It hurt like a b*&%$ but...I managed to get through it because he made me feel at ease.

    Practice makes perfect.!

    By Blogger Cari, at 8:23 AM  

  • it doesnèt need to be
    incorporated into the routing..
    you really either have it or
    you donèt...
    and you clearly do...
    in your humane observations and
    of course your smile...

    never ever lose it...

    By Blogger Maddy, at 10:26 AM  

  • I always read your posts at least twice, angel. Once for the pleasure of simply reading and another to see if I have a worthwhile response.

    “It was in your smile.” Some things, I guess, you have or you don’t have. Some few things that you don’t have can be learnt. Based on your posts here, I’d say you have the bedside manner. The bedside manner is about making a connection with someone, just like blogging.

    I think you instinctively started asking questions to make a connection with your patient, giving them something else, happier somethingelses, to think about. It also showed you gave a damn about the patient beyond the immediate exam. I hope the instructor gave you a good mark for that.

    By Blogger blackcrag, at 11:50 AM  

  • Tea and Books, etc...
    You are right, I can always sense thoughts by a person's stance/glare/smile whatever. It's something I've always been able to pick up on.

    Cari,
    Your doctor is definitely a people person. Anyone who can make a person laugh while draining pus from their mouth is definitely a Patch Adams.

    Maddy,
    Thanks for that vote of confidence.

    Blackcrag,
    I recieved an average mark. The professor remarked that I took too long in evaluation, was clumsy in my use of the opthalmoscope and BP apparatus and that my hands shook entirely too much. I didn't take her remarks to heart though. I used them to better myself.

    By Blogger angel, jr., at 12:03 PM  

  • I would drive as many hours as it takes for you to be my doctor. I'm serious! Doctors freak me out, and I have seen many doctors. Most of them unfriendly.

    By Blogger the_mrs, at 1:50 PM  

  • I think you would be a sweet Dr. I had a Dr in Uni who had a great sense of humour and I always enjoyed going to see him. On one visit I had a weird skin rash and he asked me to take off my clothes. I looked at him and said "All of them?" and he said "Yes, why? Is that a problem?"
    I looked at him and said "No, but that is like intimacy without dating"
    He cracked up laughing. That made the whole thing so much better that he appreciated my sense of humour.

    By Blogger No one asked us, at 2:04 PM  

  • bedside manner is extremly important. with so many docs out there, and the fact that normally you see a different doc each time u go to the doctor, it helps to have someone you can trust and talk to. going to the doc can be embarrasing for some (like me)..lol and some people don't trust them, like my dad.

    By Blogger vani, at 2:31 PM  

  • I thought it cool that even though you were nervous the patient would see you again. And it was a very good compliment that he could tell you were a doctor from your demeanor.

    By Blogger :P fuzzbox, at 2:43 PM  

  • Hi the_mrs,
    Wow, that's one of the best compliments I've ever received.

    No one asked us,
    You know it also helps if the patient has a sense of humor. I've got another post concerning this, which I'm going to post later.

    Vani,
    Yeah, I know about causing nervousness in some patients. When I was a fourth year medical student, I noticed that the pediatric residents wore a different colored lab coat then the rest of the residents. I asked why and they said so that children don't see the white lab coat and freak. I thought, you guys are fooling yourselves. Children are not idiots. They are just young.

    :pfuzzbox,
    I thought the same thing myself. I went back to update my history and the patient smiled and said, you aren't trembling today. The patient was very kind and taught me my first valuable lesson: Never let them see you sweat. But always be honest in dealing with one.

    By Blogger angel, jr., at 3:01 PM  

  • You are 100% correct. Bedside manner is everything. I am not a fan of hospitals and have a bit of the white coat syndrome. The Doctor that I have now has great bedside manner, and that is why I stay with him.

    That is too bad that you have to order the Coupland books, try Microserfs first, it will be a bit cheaper because it is out in paper back. It is solid!

    Scott

    By Blogger Scott, at 3:24 PM  

  • I think that perhaps a doctor's true talent is to be able to suss out what's wrong with a patient that they are uneasy/unwilling/embarassed with disclosing.
    (ie depression etc)
    It takes a true talent to be able to ease someone into that level of comfort.
    Cheers Angel!

    By Blogger Tai, at 5:29 PM  

  • A good teacher, to me, never forgets what it was like to be a student. The same goes for good doctors understanding what it's like to be a patient.

    You're a GOOD doctor, Angel!

    By Blogger JJ, at 5:54 PM  

  • That's a good story. But if you are a medical student, how do you have so much time to blog!

    By Blogger Big Ben, at 6:52 PM  

  • Scott,
    Okay, I'll try that book first.

    Tai,
    So true, it's hard sometimes to get a patient to talk.

    JJ,
    I'm the worst patient.

    Big Ben,
    I've graduated medical school already. I'm studying for my boards--sanity is blogging on my study breaks.

    By Blogger angel, jr., at 7:09 PM  

  • Well done, Angel, on the wonderful bedside manner. What an enormous compliment to have received, even though you were very nervous.
    You will be one brilliant doctor.
    Take care, Meow

    By Blogger Meow, at 7:31 PM  

  • What a lovely post, Angel... I had a student nurse assist me during pregnancy and, despite her nervousness, she was wonderful. People who care deeply for what they do are often their own worst critics! :)

    By Blogger kimber the wolfgrrrl, at 7:56 PM  

  • Angel, you sound like you have the right touch. Your bedside manner sounds very pleasant. It is good to hear you feel you can learn from the patients. That will make you an excellent doctor.

    By Blogger Lee Ann, at 10:48 PM  

  • You sound as if you are going to be a wonderful doctor - and healer. To quote a line from one of your favourite books (The Little Prince):

    You only see rightly with the heart, what matters is invisible to the eyes.

    Josie

    By Blogger Josie, at 11:06 PM  

  • That's a cool story with a cool lesson. thanks for the parable dr. Angel.

    By Blogger slopmaster, at 12:58 AM  

  • I have come across doctors who may be wonderful, but have no bedside manner..or ones who touch me really weird..if ya no what I mean..

    I can you will be wonderful..may I call you Dr Angel?..teehee

    By Blogger Bossy♥'s YOU, at 8:32 AM  

  • Great story, I just passed it on to a couple friends who are first year med sctudents.

    By Blogger Etchen, at 6:08 PM  

  • You will be a doctor superior to the Star Trek variety one day. That day is now. Rent an RV.

    By Blogger Gyrobo, at 10:13 PM  

  • The inspiration is contagious:-)

    By Anonymous Babette, at 1:58 PM  

  • Angel I think you'll be a great doctor and it's already apparent you have a wonderful and calming bedside manner. If anything you can bore your patients with stories about us. Heh...

    I'm currently looking for a new family physician. The problem is I keep finding these "doctor mills" as I like to call them. They have like 20 doctors at one clinic and have great hours for patients but the problem is they run in and run out. I went in there with a list of questions I wanted to ask the dr one day and she let me ask 3 and told me I'd have to schedule an appt to come back and ask more. WHAT? She was in with me for less than 10 minutes. I don't want a therapy session but I have questions, damnit! :) I know you won't be like that.

    By Blogger LostInTX, at 2:49 PM  

  • Great lesson.

    I have "white coat syndrome" myself, and it take awhile for my blood pressure readings to come down.

    By Blogger The Phoenix, at 6:44 PM  

  • Bedside manner is definately important. Patients are worried about what is wrong with them and they need the doctor to show compassion and caring for them and confidence in what, he the doctor, is doing.

    We are on an HMO and the last time I went in, the doctor had no idea who I was. He couldn't remember me from Adam. I suppose he would know me if he saw me more than once or twice a year.

    By Blogger Lucy Stern, at 7:00 PM  

  • angel, can i say how amazing this post was??!! you are freakin awesome mister, please bring this with you throughout your career.

    and BE NICE to nurses!!! will get you far in your professional life, or at least make things easier! LOL!

    m

    By Blogger mollymcmommy, at 12:07 AM  

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