From class time to patient time

So last week Thursday, I slept through four alarms and found myself almost an hour later to my "Practice of Medicine" class...something we GW med students like to call the "touchy-feely side of medicine". So I snuck in late and as my small group wrapped up the discussion, my physician mentor called upon the late person (me) to do the first standardized patient interview. These are actors who get paid by the med school to act out as patients in a clinical setting. I did read the required readings, but completely missed the discussion on who my first patient was going to be. However, I found out really fast just what I was in store for. Needless to say, there was a vomit of mistakes as I fumbled through one of the most uncomfortable exercises I have had thus far in medical school.

My "patient" was a 17 year-old female who came into the clinic for her first woman's wellness exam because of complaints of vaginal itching and redness. Her mother accompanied her, explaining that her daughter had something "not sexually-related going on down there". Of course, me being me and because I missed the discussion, I outright asked the "Are you sexually active?" question right after the young patient described her symptoms of itchiness and redness on her vagina.

First, I must commend the actress who played the part of the controlling-but-yet-forgivable-because-her-duaghter-is-17 mother because she did her job well. By the time I was done interviewing (miserably) and was able to successfully kick out the mother from the examining room so that I can get the "real" answers from my fake patient, I was sweating profusely and completely exhausted. I was exhausted because I really didn't know what part I had to play here. If I was really a physician in this scenario, it would have been a lot easier to explain to the mother that her daughter is almost an adult and that regardless of whether she was sexually active or not, she is on the cusp of becoming an adult and needs to be treated as one now. But, I understand how hard this would be for any parent to do...letting their kids become independent individuals. It's a tough decision, which is why I stumbled shamefully all over myself in this interview.

Anyways...this whole scenario wasn't the point of this blog. Today, I took a full history for a new obstetrics patient for my physician mentor. The patient is a 19 year old who was accompanied by her mother and the father of the baby, who is also 19 years old. I knocked on the examination room door and walked into this crowded room and just prayed that this mother would not be like last week's mother. Oh my goodness...because if that was the case, I really don't think I would get through the million questions I had to ask from every new OB patient. Luckily, the mother was silent (she was texting in her iphone the whole time) throughout the whole questioning except for once when she piped up to the FOB (father of baby) that he needed to answer my genetics questions as well. She wasn't really paying attention to the fact that I was asking him the questions as well and he responded to my questions by shaking or nodding his head. Although this interview was nowhere near as uncomfortable as last week's fake scenario, it was still a little weird to be asking all these personal questions from my patient with two other people in the room.

So I successfully got through asking all the questions, including when she thought her last menstrual period was and calculated how far along she was in her pregnancy (about 10 weeks according to the wheel). I then left the room and presented my patient to my physician and we entered the room to do the physical exam, pelvic exam, and pap smear (which I did...yay!). Low and behold, home girl was off in her date by two months! We felt the size of her uterus and approximated her pregnancy to be closer to 18 weeks instead of 10 weeks. Now this news wasn't received very well by our patient. She seemed very sure that her last period was 10 weeks ago. The only one smiling was the "father of the baby"...who was happy by the news maybe because he has some information the rest of us did not have...

Now this drama... my class and readings did NOT cover.