Pretend Patients

Last week, we had the joy of experiencing another OSCE exam. The OSCE exam consists of several rooms of standardized patients pretending to have some common complaint seen in an outpatient setting. The actors come in and tell us they have back pain, or chest pain, or burning with urination, and we ask them the standard questions. Have you had a recent fall? Does it radiate to your jaw? Are you sexually active with men, women, or both? What we never do is evaluate these fakers for what their symptoms really resemble - Munchausen Syndrome - a factitious disorder named for the German Baron Munchhausen (see photo) who liked to travel from town to town telling fantastical stories. These patients not only see several (potential) doctors throughout the day for attention, they've figured out how to get paid for it! They try to convince us they actually have back pain, but the limp is clearly feigned. They claim chest pain, but their S1 and S2 sound healthier than mine! I wonder what kind of reaction I would get if I told the fake patient that I simply can't ethically provide them an invasive test with the lack of symptoms on physical examination, but I can refer them to psychology if they are willing. I don't think the joke would be funny enough, totally not worth it.

In other news, I'm sad to see the end of internal medicine means the end of ethics class. I don't know why, but ethics sessions were the only part of medical school where I actively participated. I often interjected my opinion loudly with well though out, extremely liberal, socialist jargon. With all the conservatives in the class, I sometimes felt I had to stay true to my hippie roots from Boulder. I was so loud that it got to the point that with Mariam and I sitting off to the corner I wondered if I shouldn't notify the class that I am not in fact gay, but just really against denying anybody health care based on sexual orientation. For the rest of internal medicine, one student would turn to me for my opinion whenever anything vaguely liberal was brought up. "You believe in socialized health care don't you," he would say to me accusingly. I would promptly reply with, "You know it, I'm the only fraking liberal here." I sometimes would confuse this student by saying things like, "I can't believe that liberal biatch Tina Fey gets to play Sarah Palin." He would then ask me, "You're a Republican?" - yet another sign my face is too serious when I'm being sarcastic. I'm actually pretty moderate, but I think I just really enjoyed disagreeing with everybody - though, I usually also disagreed with them.  Now enjoy this clip of that liberal biatch playing the glorious Sarah Palin - what a hottie!!

--By Farrah, who got her first professionalism report yesterday for sleeping all the way through her family medicine orientation (I had two alarm clocks set, wtf!) - only two more reports and I get a verbal warning, oooooooh I'm sooo scared

My Sparkling Personality....

I am a huge fan of self-aggrandizement. For example, I think about my sparkling personality quite often. Other adjectives I use to describe my personality are "infectious," "witty," "sweet," "quirky," and even "eccentric."

In my 19th century British lit class, my professor once said of Oscar Wilde: "He was such an incredible conversationalist that his friends were amazed at his on-the-spot witticisms." At the time, I thought how weird it was that Wilde was remembered for his conversational skills rather than say, the convoluted genius of The Importance of Being Earnest. But then, eventually I wondered if I was the reincarnation of Wilde, an incredibly witty conversationalist, a type of person whose witticisms people remembered and posted on their Facebook profiles under "Quotes" (the 21st-century version of Bartlett's).

Of course, I thought that my comical and enthusiastic conversational style would be very helpful to me on my medical school rotations. I thought that 3rd and 4th year would a time when I would shine - I would literally charm these overworked, tired individuals with my exaggerated Southern drawl and cute expressions. My friend Blase even told me, "I'm sure patients love you!"

Ah, Blase, if that were reality.In fact, I have had a fair share of strange, awkward moments rather than charming moments of cuteness. Instead, I have found that some of my more awkward, decidedly less personable classmates have had a better time integrating themselves into the hospital hierarchy. Here is a round-up of some awkward moments for your reading enjoyment:

1) Last week, when rounds ended, I asked senior resident whether I should shadow him for the rest of the day. He told me, "Sure, I'm going to get a drink." I started to converse with him about some inane topic, and we kept walking down this really narrow hallway. Suddenly he stopped outside a door and said, "Uh, I have to use the bathroom." I had literally followed him to the door of the men's room without realizing it.
"Uhh..sure! Sorry!" I said and quickly booked it down the hallway. Yesterday, he actually told me in advance he was going to the bathroom so I wouldn't make the same faux pas again.

2)I was obsessed with trying to bond with our senior resident even though he was a strictly business. One day, he told us to read a boring biography about some doctor dude. I randomly said, "I started a humanities club at the medical school!" Silence all around. Yauss merely stared at me with an uncomprehending face that seemed to say, "Why did you just say that?"

3) One day, I went to use the phone on the hospital floor at the same time a rather heavyset nurse with over-processed blond hair reached for it. Ever polite, I said, "Oops sorry." She gave me the once-over, and rudely said, "What are you? Like 12?" Instead of saying, "Actually 11. And I'm going to be your boss one day. Unfair and scary, isn't it?", I said, "Uh, no...uh 24?"
"I must be getting old!" she said (most likely).
"Are you...uh...going to trust me when I'm a uh doctor?" I said nonsensically.
"If you learn to talk," she said. And scene, conversation over - no witty comeback, no biting remark. Just me mumbling and making no sense whatsoever. I resolved that I would give her one of my trademark withering stares the next time I saw her, but unfortunately, I have already forgotten what the nurse looks like, since all old, large ladies look the same to me.

4) #4 if too sensitive for blog, so if you are my friend and a girl, please ask me about the Aveda make-up bag incident.

Hopefully, my next rotation in pediatrics will go better - I love cute, fat babies, so if I'm unable to charm people my own age, maybe a kid will be easier to please.

--By Mariam, who thinks the Palin lady is very pretty but at the same time scary with all of her gun and anti-abortion talk.

Excuses

I can't study because my dog is sleeping on my books.  

Once again the bloggers will most likely be on a month hiatus with the upcoming shelf exam, but blogs to look forward to (if we ever manage to finish them) when we're back on track:

1.  Farrah and Mariam go to Zingerman's a la Harold and Kumar go to White Castle

2. My opinion of internal medicine

3. A woman vice president!?!?  Hitting that glass ceiling sure gave me a headache!

4. More pictures of my dog!

--By Farrah, who misses you, yes you, I miss you.