Charts

My summer work involves helping an orthopedic surgeon with some chart research. Here are couple of things that I thought were funny.

"patient appears to be significantly older than she claims"

I love how every patient seems to be described as pleasant. For instance, "Jane Smith is a pleasant young lady who presents to my service with..."

Referencing a 50+ year old: "The patient is here with her parents."

On a surgical note there always has to be a diagnosis. So commonly you would see something like "Diagnosis: left distal comminuted fracture of the radius." But because you need a 'diagnosis' for every procedure, when someone is just having surgery to remove plates and screws the diagnosis reads "Retained Hardware." As if some patients' hardware magically disappears when they no longer need it, while others have to come back for surgical removal.

For some reason it seems that doctors need to go over the top in thanking referring doctors. Many read like this, "Dr. Smith kindly/graciously/generously refered patient X to me to treat her..."

Objective Structured Clinical Examination

Today I took the first of many examinations involving standardized patients. It's called the OSCE, but to call it anything more than a checkpoint that 99.9% of med students pass with flying colors is giving it more credit than it deserves.

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Here's how it goes at the best medical school in the country:

You arrive at a floor of an old hospital and stand around and wait for a few minutes with a bunch of other medical school students that are just as nervous as you are even though you all know there is nothing to be afraid of.

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You have some idea that this is going to be a pretty straightforward case ("my elbow hurts"), but the med students who just finished joke that they "never expected that the patient was going to be playing the part of a deranged psychopath," as they walk past.

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Next your herded like cattle into a room where you are given some basic instructions, but all the while the proctor is talking, students are frantically scribbling notes of all the questions that they want to ask while they are in the room--only to find out that you had a few minutes to write after the instructor finishes talking.

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Overhead you hear a mechanical sounding voice say, "Three minutes remaining! Three minutes!" Which is a warning to the students who are currently interviewing patients in rooms 1-10.

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All the while I'm thinking to myself, "What if I seize up in there and forget to do things in the right order, or I ask all of the questions in too mechanical of a way." Or, "What if my patient is a total jerk like the guy that I had to interview during one of our small group practice sessions."

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Then time was called, all of the medical students in the waiting room exit and find the room to which they are assigned (mine was room 5).

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As I'm standing there, my mind is going a million miles a minute. "Should I knock, or shouldn't I--or I could just see what everyone else does--but what if no one knocks and we were supposed to."

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Everyone knocked, so I did. Then I walked into the room and handed the grader (there is a patient and a grader in the room) a sticker with my name on it--from then on you are expected to completely ignore the grader.

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Here's a synopsis of how the interview went (I lucked out and got a really nice patient):

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Me: Hi Mrs. Samples, I'm a medical student at Wayne State--What brings you in today?

Mrs. Samples: Well I've been having this stomach pain for the past few days.

Me: When did it start, what makes it better or worse, how severe is the pain, what kind of pain etc. (waiting in between questions for her to answer)

Mrs S.: 2weeks ago, worse with spicy foods, 5-6, burning

Me (because I knew we were being graded on transitions): So in order to delve a little deeper, I'm going to ask you some questions about your Past Medical History.

(and so on, until I got to social history when I asked her about whether she was sexually active with a partner--which is how they want you to phrase it)

Mrs. S: A PARTNER, I am with my HUSBAND if that's what you mean (she said it jokingly, but her volume took me aback)!

Me: I see. (mumbles something else)

(next up was alcohol--I thought that we were supposed to ask specific questions if someone said they drank anything at all)

Me: So Mrs. S do you drink at all? Alcohol, that is.

Mrs. S: Well I like to have a couple of imported beers every few weekends.

Me: Have you ever felt like you should cut back.

Mrs. S: TWO BEERS, have I ever felt like I should CUT BACK from having TWO BEERS a week. No I haven't

Me: (tentatively) Has anyone ever been annoyed by your drinking?

Mrs. S: ANNOYED BECAUSE I HAD TWO BEERS!?

Me: (not getting that I probably don't have to ask these questions) So I take it you've never felt Guilty about your drinking or had an Eye opener?

Mrs. S: NEVER

Me: Okay, I think it's time we take your blood pressure (which I think I got a little low, by then I just wanted to get out of here--I finished in 12 minutes but most everyone else took less time)

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Then we were sent off to a room to write a SOAP note before we were free to leave. One of my friends had a doctor in the room who asked him if there was "anything else he wanted to ask about the patients past medical history," which worried him because he thought he had already asked all of the questions. I'm just glad I got a trained grader instead of a doctor.