Friday, July 15, 2011

“How does it make you feel?”

Talking to people is not as easy as it looks.

I remember one scene in a movie with Lindsay Lohan and Jamie Lee Curtis (Freaky Friday), where they accidentally switched bodies, and it so happened that Jamie Lee Curtis’s teenage daughter had to fill in for her at the clinic because of the “body switch”. Well, there was this one scene where the kid (in her mother’s body) took on her job as a psychiatrist/therapist, and started asking the patient “How do you feel?” every time, with the patient not minding at all…and supplying answers, totally unsuspecting that anything was amiss.

In the movie, it appeared like that was all “shrinks” did…asking what people felt about everything.


After having taken my first ever oral exams last week, I therefore conclude that this is not so.

It is so much harder than that.

The set-up was that we had 40 minutes to get the patient’s history, do a complete physical and neurological examination, and after 10 minutes of “integration” and writing out our notes, we were to present the patient’s case and our management.

Now, it does seem to sound rather easy, I suppose, but it’s nicer to hear, because while you’re there, it’s a whole new different ballgame.

That day, I woke up extra early, reviewed my notes which I painstakingly did the night before, and when it was time to get dressed, I chose a white long-sleeved shirt, grey slacks and black flats…put my hair up in a bun, and hoped that I looked serious enough to be believable. When my turn came, I went in, greeted my panel (there were three), and then brought my patient in.

He was a patient from the out-patient department, chosen by one of the second year residents because he was fairly stable, and was very verbose about his symptoms. But I did not know of this beforehand, of course.

Well, I did my interview, and felt like I was pressed for time, because I knew I had to get everything in within the 40 minute time frame allotted for us. It was so…scary. I felt like I had to get everything together…make sure I was asking the right questions, and then afterwards be sure to do a complete Physical and Neurologic exam. So, anyway, after 40 minutes, one of the consultants held up a sign, telling me that my time was up. I thanked the patient, escorted him out, and then afterwards, I was told that I had 10 minutes to integrate everything that I had gleaned from my interview, come up with a diagnosis and differentials, and then state my treatment plan.

Ok, so I did all that, and then afterwards, I got my evaluation. I learned that I had no problems with presentation, they thought that I presented my case really well, had no problems speaking in English (well…), and did not even look nervous. The crusher was when they said that I needed work on the theoretical aspect, and that I was too poised during the interview, that they felt the patient couldn’t even connect with me. well, I didn’t connect with the patient, they said, I lacked empathy. <—But that totally wasn’t my intention, of course. (And, in retrospect, it was hard to really “connect” with a patient who was psychotic.)

Anyway, it didn’t go as well as I had planned. I thoroughly enjoyed the learning and the input from the consultants, but all in all, I wish I could have done better. I felt like I had the wind knocked out of me, and afterwards, I was just quiet for the whole day. I bounced back the next day, of course, like I always do (and like I always hope to be doing everytime I reach a speedbump in life), and now, I am able to dissect it more fully.

And yes, it’s not as easy as asking about feelings. So not.





  1. With the clock ticking and "judges" watching, it would be hard for anyone to truly relax and be able to connect with a patient--much less, as you mentioned, a psychotic one. I'm glad you bounced back because, based on what they told you, I'd say you did a great job and will only get better with time and experience.

    Remember this experience when you are in the judge's chair in a few years. =)

  2. :) I'm glad you're holding up tep. :) Next month, Grand Rounds...:)



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