January 24, 2008

• Reassurance

  SO today I had a standardized patient exam for psychiatry. Which is basically sane people pretending to be crazy while i talk to them and try and diagnose which kind of crazy they have.

  All in all, nothing too exciting, and by this point in my career i am pretty used to having standardized patients. They pretend to be a patient, I pretend to be a doctor, everyone has a good time all around.

  However, it was nice to hear the feedback from these patients and learn that I am definetly growing professionally in my ability to relate to people and beginning to accquire my own style of doctoring. I personally detest taking notes, though of course the sheer amount of information exchanged sometimes makes it necessary. Instead, I usually try and recap or summarize my patients complaints a couple time during the interview. In addition to making sure the patient and I are on the same page, I can remind myself of important things to know, and see if i can catch the patient malingering or remembering previously missed info. I also apparently am able to build a rapport with patients relatively easily, which is also nice to hear. On the whole, both my patients made it sound like I am progressing as expected and perhaps even a little above average in interpersonal skills.

  Which given my standing in pure academics, i should be thankful for…cant be good at everything, right?

  So briefly, I have mentioned numerous times in my posts that I am working up a patient or doing an H and P. But what exactly is that? Well, it stands for History and Physical, and it is basically a short little life story of you, the patient containing all the information (hopefully) that I, the doctor, need to form a diagnosis. I ask about the circumstances that brought you to the hospital, all your related symptoms, things that make you feel better or worse, if that reason has ever brought you before all sort of details that they teach us in med school are important together. This part of the history is called the HPI or history of present illness

  Next is the past medical history. This could be anything medically or surgically significant that happened to you before, but perhaps may not relate to your current illness or concern. It is still important, because if you have a history of say, addiction, I may be less likely to prescribe you a medication for your current problem that could be addictive

  This is usually followed by family history and social history…that is the medical conditions or problems present in your family since many disease have genetic components and can run in family trees. Social history is about you socially-your work, living situation, alcohol and drug use, sexual activity, environmental stressors

  Finally, i ask about current medications, if i didnt already cover it in the HPI. This is importnat because new drugs, drug interactions, or incorrect dosing of drugs can all cause problems in addition to whatever you may be taking the drug for. Herbal supplement and over the counter drugs go here too!

  A good history and Physical has two main components
  1. It should read like a narrative-by the end, i should know who you are, why you are here, and what the most important details are of whats bothering you in a chronological order
  2. It should argue for your diagnoses. While I am telling my story, I am telling it to other medical professionals who i am trying to convince of my diagnoses. So if i am thinking the problem is a heart attack, then i will emphasize patients risk factors and family history of heart disease, whereas if i think depression, i will pay more attention to patient mood, thoughts and social history than their heart sounds

  Regardless of the specialty, every doctor has to master both the science of medicine (the h and p and the clinical knowledge) as well as the art (interpersonal skills). Granted some specialties emphasize one more than the other but the point remains. I am glad to say i seem to be coming along nicely in both, which with little more than a year to go until graduation, is a reassuring feeling

  • 5:55 pm
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