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