My First "Real" Patient Exam

Anna Burkhead -- Last week I wrote that I was looking forward to Community Week, which is where we head out to clinics across the state to get a little experience with “real” patients. This was my last Community Week, and since I’ve been going to the same clinic for the two years I’ve been in medical school, I’m really going to miss it!

My hours at the clinic consist of interview, physical exam, report to physician… interview, physical exam, report to physician. This routine is great to build my comfort level and boost my confidence. But towards the end of the week I’m usually aching for something different, something concrete that I can learn and do, like a punch biopsy, mole removal, or learning to stitch. (As I’m writing this and reading it over, a thought creeps in… should I be a surgeon? I slam the door quickly on that notion! Not the job for me!) While I hope for a case with something more procedural, I’m also praying that the next patient is the same as the one before! In this way, I’ve found a strange paradox for myself in medicine: I want to try new things and be “tested” on things I don’t know, and at the same time I want to stay in my comfort zone, where I know I am capable.

The week passed pretty uneventfully. I did my “interview, exam, report” performance many times each day. By the last day, I was both disappointed and relieved that I didn’t have any “new” experiences! While my doctor and I were eating lunch and preparing for the last part of the day, the nurse came in and announced that there was a learning experience waiting for me in the exam room. The patient was a young girl who had made an appointment for her annual pelvic exam and pap smear. She wanted a female doctor to do her exam. The physician I work with is a man, the PA in the clinic had a packed schedule, and so that left … me?!? I had been trained on the pelvic exam, and had practiced on a member of the training group, but had never done the exam on a “real” patient. I was at once very excited and very nervous. (For all you experienced doctors and “seasoned” medical students out there, this might not seem like a big deal, but try to remember your first time; you might have been nervous too!)

I went in and talked to the patient first, to let her know that I was a medical student, and to make sure she still wanted me to do the exam. My physician reviewed the “tools” with me, gave me a few words of advice, reminded me that he’d be there to help, and said, “go to it!”

When I entered the exam room again, I reminded myself to try and appear confident, because the patient was probably anxious too. I washed my hands. As I began the breast exam, I could feel my knees shaking a little bit, and I wondered if the patient could sense my nerves. Then it was time for the pelvic exam. My mind was racing, but I thought back to what the trainers had taught me, and I let my memory be my guide.

Before I knew it, the exam was over. I left the room so the girl could dress, and when she finished, I asked her a few more questions and answered hers. It was only after she took her form to the check-out window that my heart slowed down. I re-played the exam in my head, lining it up with my mental notes from the training. Warm the speculum … check. Introductory touch … check. Describe to patient what I’m doing … check. I think I got it all!

Now it’s a few days later, and I haven’t received an email from the doctor saying the lab results came back with an “Insufficient sample” report, so that’s a good thing. It appears as if my first hands-on experience with an unfamiliar procedure may have been a success!

Next on the agenda: I have only two more months of second year. Third year is spent on clinical rotations through the specialties, and I have no doubt that I will experience many more “tests” like this one. I’m just glad to get the first one out of the way!