A model patient in physical exam class

In the New York Times article “18 Stethoscopes, 1 Heart Murmur and Many Missed Connections,” Madeline Drexler tells her story of being a model patient. Not like a model citizen cooperative and pleasant but, a person with a medically interesting finding who is asked to help teach medical students. These “patients” are examined by small hoards of inexperienced medical students who have little knowledge, little skill and varying degrees of innate bedside manner.

I was fortunate enough to go to a medical school where we began examining patients – real and staged ones – from month one. I still remember many of these people well; more clearly perhaps, than those I cared for in my sleep-deprived haze of residency. As Ms. Drexler describes, I am certain that back then, I too was filled with awkwardness and overtaken by my interest in the examination findings at the cost of expressing empathy.

There is one that comes to mind now. He was a model patient for my final exam in a class on physical examination. I think he might have been the bonus “question.” I had studied hard. I was tired. He was in a room behind a door I nervously opened to find the answer to what exactly was different (medically speaking) about him. There in the room, on an exam table sat this young man. He may have been 25 or so, dark haired, bespectacled and calm. I approached him and began the work of examining his body for a “finding” of sorts. Heart, lungs, abdomen? All depressingly normal. Mouth, neck, ears…getting closer. Then to my joy I found “it” and remember well the thrill when I did. There was a big part of me that wanted to say ” Woo Hoo! I did it”! Ms. Drexler describes this reaction in other students:

“This was a student who is not uncaring or unkind,” Dr. Treadway told the class. “But in that moment she did something all of us do all the time: she was so engaged with the problem that she forgot about the person who had the problem.”

I had a favorite attending doctor in medical school. Everyone else was scared of him. I looked up to him. Sure, he asked the hardest questions and embarrassed me at times. I stood tall with the knowledge he was doing this to make me better. And, when I watched him with patients and parents I saw that all of his sternness evaporated; he became the most caring doctor in the hospital. He asked, as Ms. Drexler reminded us to do, about how it felt to be stuck there as patient or parent. When he was talking with a family it seemed that perhaps, time had stood still. He had no where else to go, nothing else that mattered more than the people in front of him.

I think of this man often. He motivates me still. And, what I know now after all these years, is that I am still learning. Every visit with every patient I strive to become better at listening, interacting, understanding. I reach for the ability to make them feel that time has stood still in that room with them. I am not there yet but – reading Ms. Drexler’s words and remembering my attending’s gifts help me feel that I might, just might get there some day.

P.S.: The answer to the bonus question was prosthetic eye.

Kate Land is a pediatrician who blogs at mdmommusings.

Submit a guest post and be heard on social media’s leading physician voice.

Comments are moderated before they are published. Please read the comment policy.

  • http://secondbasedispatch.com/ jackiefox

    What a wonderful post! I loved your description of how time seemed to stand still with your attending. I can attest to how important that is and how we patients notice it. All four of the docs who treated me for DCIS (family doc, surgeon, oncologist, plastic surgeon) had that quality. I was always amazed at their ability to focus on me and only me when they walked through that door, as brutal as their schedules are.

    • http://twitter.com/KateLandMD Kate Land MD

      Thank you.
      It is a wonderful thing to be able to help our patients feel so well cared for, to give them the gift of our fullest attention. I strive for that ability and realize the gifts I will receive in turn when I too someday, live up to his teaching.

  • http://twitter.com/DrEdPullen Edward Pullen

    I remain indebted to the model patients for pelvic and digital rectal exams, who patiently told us what hurt, when we were too timid, etc.  Priceless experience.  

  • http://twitter.com/HeartSisters carolyn thomas

    Thanks Dr. Kate for sharing this NYT piece by Madeline Drexler. I was struck by how few of these students exhibited even the most basic of courtesies, like saying ‘hello’ or ‘thank you’ or even introducing themselves. There are few things so clearly invisible to many docs as a patient in a paper gown.  I suspect it must be this gown that removes our humanity and reduces us to just Bed 8 or the 10 o’clock procedure, and it seems this vision problem starts with med students!

    When I was asked (as a heart attack survivor) to address the annual ‘Cardiology Day’ audience of docs, nurses, techs, students, residents and fellows at our local teaching hospital (also videoconferenced regionally to a far wider audience of cardiac types), the piece of information that caused a visible stir was not about valve damage or ejection fraction, but my simple plea to them to not ‘talk over us’  – as if we’re not even there, lying on the gurney, afraid and confused, a piece of meat on a slab – but worse, like an invisible piece of meat on a slab. 

    While you’re examining us, or while you’re moving our gurney from department to department, please do not chat with each other about your weekend plans, your kids driving you crazy, last night’s clinic meeting, or what’s on today’s lunch menu as if we don’t even exist.  Please look us in the eye, introduce yourself by name, explain the procedure or test and what’s happening next.  It’s just good basic training for common courtesy in real life.

Most Popular