Playing Doctor

I gotta tell ya, I looked the part: dress clothes - no tie for hygiene and a little for rebellion (my dad understands); and white coat - pockets filled with instruments, reflex hammer, tuning forks, and whatever other crap might make me look legit.

Now I had to play the part: this was my first "solo flight" into a complete medical history and physical exam. We've been doing histories for months now, and I feel pretty comfortable with asking open-ended questions, letting the patient tell their story until they stop or their story starts "swerving around", asking some follow-ups or retelling the story as I know it, and being generally charming - side note: old people coincidentally LOVE me.

But today I have to poke, drum on, listen to, and occasionally whack (CVA tenderness) someone in just the right way, step back and look thoughtful, then do it some more. And further, my first time is on a fourth year med student, assigned to (quite convincingly) play a guy who has knee pain. He knows when I don't know what I'm doing.

"Where's it hurt, when, how bad, whens it worse or better, and who are you having sex with?" Of course that's not the exact progression! But it turns out, that last question was key...the kid had the Clap! (gonorrhea). For good form I did every exam there was - its supposed to be a learning exercise for me - but I saved the best for last, yanking back and forth on his knee while he winced and sighed. This guys was good at making me feel like a monster for hurting him, but that's part of the MD stamp I guess.

It was all completely pretend, and at times we'd break role and talk about techniques etc, but for about an hour it felt quite real. I felt both knowledgeable and like a complete fraud simultaneously. Afterwards I was completely drained. How am I going to do this every day, all the time?

The more I reflect on the experiences related to my professional development class (learning histories and physicals), the more I feel exactly the opposite from the above paragraph though. Only months ago, I was completely oblivious to the intricate art of Doctoring....how exacting the interaction is, extracting clues from the words a patient uses to describe their symptoms, and the subtle signs their bodies give up to betray the disease within. I feel like Encyclopedia Brown, my childhood hero.

I had a talk with a family doc at my church about the actual use of history and physical exam in diagnosing disease in these days of billions of lab tests and imaging techniques (ie x-rays, CT, MRI). While "seeing" the problem physically (imaging) or chemically (labs) appeals in its simplicity and covering your @$ from getting sued, what is truly gained other than a much larger doctor's bill?....seriously, that stuff is pricey.

Maybe talking to your doctor and having him drum on your liver is old-fashioned. Now are the days of full-body MRI's and Comprehensive Metabolic Panels.