Tuesday, August 25, 2009

We Talkin' Bout Practice, Man

We're thrown fairly quickly into the fire. Mind you, it's not a conflagration, rather a controlled burn. Today, with seven days of lecture under my belt, I walked into a mock exam room and took a History of Present Illness (HPI) from a standardized patient. I haven't even met my cadaver yet (stay tuned, as that happens this coming Monday). Sure, my classmates and I have attended a lecture on the content of an HPI as well as a lecture on professionalism and communication in the exam room setting. It also helps that we are presented with very straight forward cases by actors/actresses trained for this purpose. I might have been slightly nervous knocking on the door of the exam room and introducing myself, but the experience was fantastic.

While buried in the tall weeds of first year basic sciences material (to date: Embryology, Clinical Molecular Cell Biology, Biochemistry, Anatomy, and Physiology and Histology will join the fun shortly), Essentials of Clinical Reasoning provides a little glimpse of why my classmates and I are here. You may consider it strange that we are learning to conduct a short patient interview that produces something like 80% of all diagnoses before we are anywhere near equipped enough to generate a differential diagnosis. I wondered that myself.

As it turns out, there's more nuance to an HPI than I could have imagined. I'm not sure it struck me before, but much of the information necessary to start diagnosing a patient comes directly from the experience of the patient and must be extracted carefully. They know where they hurt, when they hurt, how much they hurts, what has made their pain better (or worse), and so on. Quickly generating a good rapport with and getting useful information from a stranger takes practice. While our standardized patients were forthcoming and cooperative, that won't always be the case. At some point, I'll likely be dead tired, too hungry, or grumpy and will need to get useful information from someone who is uncooperative. I won't always be so lucky as to get a smiling patient with one symptom and no other problems. So, why did I find myself in a white coat asking a faux-patient about her recent onset of stomach pain after seven days of lecture? As one of the Associate Deans is fond of saying, it takes 10,000 repetitions to master something.

That's one.