Quoted for TRUTH.
Though I’d save Board reporting for stuff I know the Board would act on.
And I use Chiros as a sort of meta-therapist for musculoskeletal complaints of the back and neck that can give temporary short-term relief perhaps better than meds or doing nothing can.
Well, the first thing was how I was dressed. I was kind of like, “bwuh?” I was wearing black pinstriped trousers, a black blouse, and gray loafers and my white coat. She said I was messy. Now, granted the blouse was a little loose and the pants a little long, but it’s hard to be very well dressed and comfortably move around to check blood pressure, look in the ears, nose, percuss, auscultate, etc.
She also said that I skipped around a lot in my questions, which is fair, and a good point. I am a little rusty on this. I could have organized my presentation to my preceptor A LOT better as well, but she didn’t see that.
Finally, she said I was unprofessional, but didn’t really elaborate. I think there might be a couple of reasons
I also asked her about her work life, social life, etc. Maybe she thought that was unprofessional? The thing is, we’re taught to take a social history. I also asked her about her parents, for family history.
Oh, and finally, when I asked her to lie down on the table, I didn’t pull out the leg rest. That was probably really uncomfortable for her, and a bad move on my part.
Anyways, since she was basically paid to be a “patient,” I would have appreciated more specific feedback.
[QUOTE=Gestalt;13102380
Anyways, since she was basically paid to be a “patient,” I would have appreciated more specific feedback.[/QUOTE]
Interesting - I don’t know how this works. Was she actually sick, or is this just a role-playing exercise?
Yah, I probably got a little carried away there. 
Out of curiosity, what level of woo-i-ness is the sort of thing that most Boards would be interested in?
I read the phrase “alternative treatments” as
“treament alternatives”
not
“alternative medicine”
As in, steroid shots and icing regimes are treatment alternatives for a repetitive stress injury.
The other reading didn’t even occur to me until you raised it!
Just role-playing (although she did it very very well . . . she was hoarse and coughing . . .)
Basically, the med school pays people to be “standardized patients” with specific illnesses so that med students can practice on them and not subject actual sick people, who have gone through enough, to our bumbling incompetence.
Oh, and thanks for all the feedback everyone . . . I’ve been reading every response and it’s been very enlightening (and encouraging, actually, because I think active listening and question asking is my best skill)
Inappropriately providing narcotics.
Sexual behavior with patients.
Trading drugs for sex really gets their attention.
As for Woo, pushing it in place of bona fide therapies for life-threatening illnesses is very frowned upon.
You’ll get the hang of it. Now’s the time to make mistakes, learn, and also learn how to take criticism for doing it the right way, too.
It sounds to me that all of those are fixable and you seem more than willing to do that. I wouldn’t characterize how you were dressed as “messy” unless the hem of your pants was dirty/torn etc. That drives me nuts. Also, how was your hair? If someones hair is messy/dirty, they could be dressed in a Chanel suit and I’d perceive them as unkempt.
Don’t become overly fixated on one review. It’s just one person’s opinion. Now if you get the same feedback on your next “patient,” then I’d fixate…
Am I a weirdo, or does QtheM have some seriously whacked-out patients? None of those things would turn me off in the least. (It wouldn’t occur to me to look up board certification, but I wouldn’t be, y’know, upset to find out my doc is certified.)
Oh.
Anyway, the only other criteria that hasn’t been mentioned yet, and is mostly irrelevant to OP’s performance review, but … I want a doctor who’s geographically close to me. I live in a huge metroplex, and I’m sorry but I’m picking whoever doesn’t require me to drive far.
My current doctor’s office is less than a mile from my home. 
And a huge, fat +1 to the “tell us what’s happening” suggestions. If a patient can’t see your hands (obgyn, rectal exam, etc.) then pleasepleaseplease talk us through everything.
Please don’t have cold hands. Probably not up to you, but GAH! that’s cold!
A suggestion I saw somewhere else was for you to go through what your patients do. So for male obgyns, ferinstance, that means climbing up into those damn stirrups. Only then will you understand why you have to tell your patients to scoot their butt up to the edge (“A little farther please. Closer to the edge. Further.”) Feels like I’m about to fall off. Now you’ll know what that feels like, too.
i love my GP. I don’t trust doctors (except for Qadgop the Mercotan, of course!) but I’m more comfortable with her than anyone else. These are the things I like about her:
[ul]
If I’m there to see the doctor, I’m there to see the doctor. The nurse can take vitals and ask what’s wrong, but I expect to see Dr. S. I don’t go to the doc unless something is wrong. [/ul]
[ul]If I say something hurts, it hurts badly enough for me to seek help. Take me seriously (which doesn’t mean painkillers, it means figuring out why I hurt and fixing it). I walked on a broken foot for 6 months before I decided it wasn’t going to fix itself. [/ul]
[ul]Because I don’t like doctors or medical procedures, sometimes I need a little encouragement if I need a test. Don’t necessarily take no for an answer, but understand that it might take me a while to talk myself into something.[/ul]
[ul]Understand that your patients are individuals, and you have to approach each one as a unique person, rather than a symptom. Some people are more analytical than others and want the facts adn figures, others want their hands held, some seek help at the first sign of trouble and others (me) prefer to wait to see if it fixes itself.[/ul]
Be nice, be real, understand that your patients are hiring you to do a job, you’re not gracing them with your presence. Continue your education. Dr. Welby is great until you realize he left medical school 40 years before and hasn’t kept up with the newest. Make sure your staff treats your patients well, too - many a doctor has been dropped because the staff are mean idiots. Understand that when I’m in that little room, I’m the most important thing on my mind - if I expect a lot it’s because it means a lot to me.
StG
Are you a woman? I think sometimes it’s harder for women to dress “appropriately”. Men can always go with the option of button shirt +/- tie and a jacket and look neat. Women… well, our clothes often aren’t designed for ease of movement. And even if we’re professionals we’re judged on appearances.
I know there has been some concern with long sleeves and ties picking up bacteria, but would a model patient (or a real patient) have that as a concern? I don’t know. But perhaps a short sleeve blouse with no ruffles/frills/lace under your lab coat would be more practical on several levels? Wearing your blouse tucked into your trousers? I don’t know. It could also be idiosyncratic to that one reviewer.
Practice, practice, practice…
Ha. When I’ve done that to a doctor usually they start making the next question multiple choice:
ME: It’s a cough
DOC: Can you describe it?
ME: It’s a cough
DOC: Is it productive, do you get mucus when you cough or does your throat stay dry? Does it hurt? Does your chest feel tight? If you cough up mucus, what color is it?
Yes, it’s not so open ended, but it lets the patient know that you need some descriptions. (Now that I’m older that not usually a problem for me - in fact, in one case I managed to make a medical student puke thanks to my colorful response to his question. Hmm… maybe sometimes I give too much information…)
That sounds like something that will improve with experience and practice.
Some people are going to view questions like that as intrusive or not relevant to their problems. You’re not going to make everyone happy all the time. (As a doctor, sometimes doing Unhappy Things is part of your job, sorry to say). Well, what I do for a living, what I do for hobbies, etc. is related to my health, you do need to ask those questions. Family history the same, although asking about siblings is important, too.
How do I get a job doing that? It sounds interesting, I need the work, and I’m willing to do my part to train the doctors who will be treating me in the future.
My top requirement for a primary care doc is simple.
As William S. Burroughs put it (in Junkie, I believe) you gotta have a croaker who’ll write scrip (prescriptions) when you need it.
He can take my blood once in awhile and even lecture me a bit on my bad habits. As long as I’ve got a croaker that writes, life is good.
Thanks for all the feedback, Broomstick and others.
Do you have a medical school near you? I would see if you could contact the office in charge of training preclinical students in clinical matters. That can be kind of confusing, so if you want to link me to the website of the school I can try to find the right contact person for you.
Just as another Medical student chiming in- they (The Standardized patients grading things) tend to frown on multiple choice questions- they apparently “confuse” and lead the patient, and the SP (standardized patients), are known sometimes to just go “yes” when you ask a multiple choice Q, forcing you to re-ask each segment of it to figure it out.
Just a lil’ note, as it IS practical in the real world to give multiple choices sometimes, but on SP’s its one of those things like asking leading questions that can get you dinged.
I think G. if you’re a first year medical student you’re doing okay- even probably 2nd year too- you just got to keep asking those questions and sort of get a rhythm in your head going for the HPI. There’s something like 260+ questions to get through, and you have a limited amount of time (at least that’s how it works at my place- 1.5-1 hour for first years, 45 mins-1hour for 2nd, and 30 mins for 3rd & 4th years, while adding in more parts to it).
So initially the goal is just to get into the rhythm. If it’s a new patient, and you’re doing a full H&P it’s fully within your bounds to ask ALL the questions- get the family Hx, the Social hx, and all the info you can. If it’s a follow up visit- then you can try to focus the interview down to pertinent systems, and even then exploring the social/family history can be key if it pertains to the chief complaint: Ie: for cough- sick contacts, work history, exposure to animals, allergens, or noxious materials at home or work, smoking history, etc).
Can’t really help you with the sloppy dress, but organizing the interview just comes with time. Open ended Qs are great for the HPI, but that doesn’t mean the WHOLE interview has to be nothing but opened ended. Also great Questions- “can you tell me more about that?” “Oh, really?” “And then what happened next?” are all great lil’ questions that basically re-ask the patient to try to elaborate on their issues, without being too narrow.
My favorite technique I’ve seen used is the “silent pause” but as a medical student it’s REALLY hard to pull it off- too easily it becomes the awkward pause, or the uncomfortable silence. But it’s a thing of beauty to watch an attending just sit there and wait for the patient to continue, I got to see quite a bit of it used in the psychiatry rotation, but was warned by the attending that it is a TRICKY tricky one to use. So don’t try that one- but learn little key transitional questions or phrases, that nudge the patient into giving more information- that just comes with time, practice, and watching others even how they interview patients.
Hang in there!
I wonder how Tarzan of the Apes would have been different if it had been written by William S. Burroughs.
Smoking bananna peels…?
Yeah, I know…nothin.
But, the obvious joke.
I’d recommend it for specialists, at least. They may have subspecialty certifications as well, too, depending on the field. For instance, pediatric cardiologists tend to be board certified in pediatrics, and then in the subspecialty of pediatric cardiology. Tip: If you learn the doc is “board eligible” rather than “board certified,” typically that means either they’re super-new, or they failed. That’s not necessarily bad; one of the best peds cardiologists I know (in skill and bedside manner) failed his first subspecialty board because he was cocky about his level of knowledge. Passed the next time, though. Then again, there was another doc who had failed more than once…
The fact of the matter is the population of the dope is rather educated and does not reflect the reality you experience with a multitude of patients. I also notice that many people follow doctor’s orders to a T here, whereas in real life, most people ignore or flub or fudge a doctor’s orders. Statistics show this.
I grew up in a medical household (2 parents physicians, multiple aunts/uncles/cousins and their assorted spouses, mostly physicians but the odd dentist or pharmacist thrown in there too). The only thing that holds true is the nice physicians, the ones who took time with the patient before treatment, are the ones who don’t get sued and are generally well liked. You’ll see physicians in the future with the personality of drapes who are genuinely extremely technically sound who are disliked. You’ll also see physicians who are friendly and kind and sweet who don’t know strep from pneumonia. And in spite of the errors they make, they will never be sued because the patient believes their physician and trusts them based on their personality, not their technical skills. Lawsuits and likes/dislikes arise from perception, not reality. Again, not always, but for the majority of the population.
So, my advice? Learn to listen. Learn people skills. Try to like your patients. Try to remember their names, or at least look at their chart before entering the room. Jot down something about them to ask them later. Try not to show them how flustered you really are. Ask your friends and family how good you are at appearing to be a thoughtful listener. But for God’s sake don’t do any of these things the expense of learning actual medicine.
What do I look for? Most importantly, I look for a doctor who tells me I’m overweight at every one of our appointments. Cause it’s a leading cause of death and disease. Many docs are fat asses themselves or feel that a person knows they’re fat. They don’t, and part of being a good physician is packaging the hard truth and delivering it, every single time.