I usually feel like an impostor when I’m wearing my white coat. This day was no different. As I walked with my classmates down the corridor, I wondered if anyone else felt that way. But then again, it didn’t particularly matter either way at this point. We were on a mission–or at least it felt like it as the ten of us trinkled into the small conference room at the end of the hall. The patient hadn’t arrived yet, nor had the physician that would be evaluating our performance. This gave us an opportunity to pause before choosing our seat. Accordingly, I lingered at the outskirts of the set of tables that formed a “U” in the center of the room. There, I surveyed the space and contemplated which spot would give me the best chance of getting out of this thing in one piece.
Seating is a delicate matter. The choice, for most people is a matter of personality and one’s own relative comfort with risk. With ten people working together to take the history of one patient, position was everything. Think about it. You go early and it’s up to you to get the ball rolling–you have to connect to the patient, make them feel comfortable, and most importantly, get them to open up–quick. You set the tone and direction of the rest of the conversation. Getting a bad start out of the blocks spells a bad race…no doubt about it.
Being first can be nerve-wracking, but so can going near the end. Going last means you have to really be on your game. You have to take note of all the questions your classmates have already covered and take special care not to repeat the same ones. What’s more, you have to synthesize all the disjointed information you’ve recieved from the patient into a coherent narrative. His or her story might not have come out linearly but you have to make it so in your head. You have to figure out what may be relevant (“the symptoms intensify when you’re at work do they?”) and what might be less so (“your sister just got divorced? I’m sorry to hear that”). Yep, any way you slice it, the ones who sit on the extreme ends of the table are either really confident, really comfortable with risk, or just plain got there late.
Me, I’m a classic middle shooter. As far as I’m concerned, the middle chair is the sweet spot. By the time it gets to the middle person, the ball is already rolling steadily; all you really have to do is keep the momentum going. Having gotten to know the patient’s situation through the questions asked by her peers, the middle interviewer can form an more informed hypothesis about what’s going on (an extremely rudimentary hypothesizes mind you–we won’t even finish our first pass through the entire human body until sometime next May). One’s nervousness has also likely waned by that point, being overtaken by a genuine interest in solving the mystery of the illness being presented.
Hence, it was with relief that I slid into one of the seats near the curve of the “U”. It wasn’t long before the evaluator arrived, with the patient of the hour in tow. They took their seats and then the clinical evaluator began to go over what we could expect in the session. The instructions were simple enough. The “patient” was really a local actor who had been trained on the specifics of a particular illness. She would be presenting this illness to us now. We weren’t there to diagnose (at this point I probably couldn’t even diagnose a missing limb with any kind of confidence…let’s not kid ourselves) but we were there to get the story of what was going on. To do that, we’d have to listen and ask the right questions.
According to our school fight song, we are “the leaders and the best”. With not one, but TEN such individuals all working on the same case, there was no reason to doubt that success was imminent…
“Who wants to start?” the evaluator chimed.
The room fell silent as the implications of her words took form in our mind. With her calm inquiry, seating order was swiftly rendered meaningless. Plan A went out the window. As the silence stretched on, all bets were off. I thought fast.
First interviewer. I could do this. A last minute change of plans, but still a relatively safe bet on my part. Going first meant my job was to introduce myself and make the patient feel comfortable. Connect somehow. I’ve always been a talker, and never really minded asking people about themselves. I figured I’d be okay.
Orienting toward the patient, I informed her that I was an M1 student interested in hearing about the problem that had brought her in today. I asked about her drive up and if she’d found everything okay. I then asked briefly if she was from the area before finally moving the conversation toward her medical problem. By the conclusion of my questioning time, I must say, I was feeling downright pleased with myself overall. I had successfully gotten her talking and even managed to cover a few key medical questions. Life was good.
Sadly, my self-congratulation was short-lived. After I finished my portion of the interview, the evaluator immediately gave me her feedback. While her comments were generally positive and encouraging, one query in particular caught me off guard.
“What’s the patient’s name?” She asked. I thought back–and drew a blank.
In retrospect, I’m sure the patient had a very wonderful name. Unfortunately, it had escaped my mind to inquire about it at the time. Not the best start.
Luckily, (feeling quite humbled) I was subsequently able to relax and take in the methods of my peers. Things seemed to go well overall. Of course there was the occasional repeated question, awkward sex history moment, or brain-freeze induced silence, but nothing major…Well, unless you count the fact that with all our questions, we never actually uncovered the true source of the patient ‘s pounding headache–i.e. the massive tumor pressing against her brain (personally, I could have swore it had to do with the noise associated with her kitchen being remodeled. Turns out they just threw that in to confuse us…see what we’re up against?).
Anyway, I’m realizing more and more that being a first year medical student is a lot like being a baby. We come into this new world, and don’t know a thing. On the first day, we couldn’t even sit-up on our own: most of us had never even seen a real dead body (outside of CSI) or so much as held a scalpel. The extent of our medical knowledge was whatever made it to Grey’s Anatomy or Scrubs each week…Things change fast.
They hand us a white coat and a stethoscope on the first day, sure, but it feels premature–because even now we’re just speaking our first words. Still, I’m trusting the process. We all have to–because in another year and a half, they’re expecting us to be able to run…