Patient Interaction

The first time, I was nervous.  I desperately hoped that my partner, whom I had happened not to have met during our entire first year and a half at medical school, would be excited and ready to do the physical exam, because I sure wasn’t – I was nervous.  We found our patient.  After introducing ourselves to her, I looked at my partner and suggested, somewhat proud of myself for thinking to do it this way, “Should I start with the history, then?”  I would obtain the medical history, and then he would perform the physical exam.  My plan was perfect.

Unfortunately, my plan was not perfect, and he was just as nervous as I was.  “Well, I could do the history, and then maybe you could do the exam…?”  He asked it as a question, but I already knew my plan had failed miserably.

Come on, Michelle, I thought.  You’re in the Air Force.  You can’t wimp out with something as small as this.  You’ve just got to get through it; it will be fine.  I didn’t want to be difficult, and I didn’t want leave my partner hanging on our very first day together.  I acquiesced.  It felt strange to be examining another human being who probably had no idea how little experience we’d had, but I had expected that.  I was nervous, but I got through it.

The second time, I was less nervous.  I was the one obtaining the medical history that time.  I felt completely comfortable talking to my patient, finding out so many details about something so personal as her own body while also establishing a trustful relationship, an easy rapport.  My partner and I talked through the exam, helping out one another.  Of course it didn’t feel natural, but at least it didn’t feel as scary as the first time.

The third time, I was excited.  By then, I was more familiar with the exam, more trusting of my partner, and more confident in my skills.  An hour before, however, I learned that my partner was sick and would not be able to come that week.  My certainty deflated instantly.  Would I be required to do the entire history and exam on my own?  I felt comfortable interacting with a patient alone, but I certainly did not feel ready to perform the physical exam alone.

The third time, then, I was incredibly nervous, but I was determined to do my best.  To say it was easy would be an egregious misstatement.  The patient was not at all talkative, answering most of my questions, even the open-ended ones, in single words or phrases.  His accent and quiet voice made it even more difficult for me to understand and interact with him.  When I had exhausted my mental stockpile of questions, I moved on to the exam with a new rush of nerves.  He knew that I was a student, but at the same time, I did not wish to appear inept.  I tried my hardest to appear as though I had done this sort of thing many times before.  Since he was a chronic liver failure patient, he had seen his share of medical students.  As I performed the exam, he told me about a time he did not feel comfortable with the student.  It did not seem to him that the student knew the right exam procedures.  I paused.  Was he hinting that he didn’t trust me?  I looked him in the eyes.  He went on, “But you – you’re all right.”  Not wanting to violate his trust, I asked his permission before I proceeded with the rest of the exam, to which he replied, “Of course.”

I’ve only participated in the physical examination of three patients, but I’ve learned so much already.  I’ve realized that it is natural and even expected to be nervous for these powerful new experiences.  I’ve also realized that as nervous as I may become, I can do it.  I can establish relationships with patients, and I can work through my own apprehensions to learn the most important skills we’ve been taught in medical school thus far.  Some exams will be more difficult than others, but that’s why I chose medicine.  I wanted to interact with people – people whose disease processes, medical histories, temperaments, and ultimately lives are all different.   I’ve been nervous, but I’ve also been privileged.  I can’t wait to continue to experience the miracle of interaction throughout the rest of my career.