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.

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