This past Thursday I had an appointment with the same patient I have been seeing since November. I am part of my school’s student-run clinic. Each patient is assigned to one team, made up of an M1, M2, M3 and an M4. As an M1, my role has been mostly to take vitals and to practice my history taking skills. When the time comes for the physical exam, a senior student takes over, or I do as much as I can remember and then ask for assistance under the pretext “We haven’t learned that yet.” I then take the backseat and relax as I observe the senior student fly through the physical exam. I take mental notes at my leisure, nowhere near as obsessively or as tediously as I take notes when I know I will be tested on something later.
However, this past Thursday was different. I was running late and texted my teammates that I was about six minutes behind schedule. I had gotten stuck in traffic and was struggling to find a parking spot nearby. Defeated, I eventually parked a few blocks from the clinic and sped walked my way over, trying my best not to transform into a giant blob of sweat. When I burst into the patient room, my M4 looked relieved. “Here she is!” she exclaimed. “We’ve been stalling for you! You’ll be leading the physical exam today. Whenever you’re ready.” I was still trying to catch my breath while at the same time mentally reviewing basic history taking and the physical exam. My mind could only get as far as “OPQRST” before awkward silence had filled the room for a bit too long and it was time to begin.
I nervously waved my hands in the air trying to feign confidence while running through the history taking portion of the exam. To my surprise, my nervousness began to fade away as confidence started to creep in. The physical exam felt natural. At this point, I had done it dozens of times before without realizing it was slowly becoming part of me. It was no longer an act, I wasn’t just pretending to know what I was doing. The end of the physical exam was followed by words of encouragement and positive reinforcement from not only my fellow classmates, but from the patient himself.
The importance of learning had never hit me quite as hard as it did that day. I had gotten into the habit of picking and choosing what I believed was worthy of my time. Practicing and trying to perfect my physical exam always took the backseat when put against studying a list of drugs, or reviewing a lecture. I hadn’t given the physical exam the respect and importance it deserves. What good is it to know every hypertension medication in the book if I can’t detect a heart murmur? What if I bypass something I think of as miniscule and unimportant and miss something big? There is no excuse for carelessness, especially in a field where the stakes are so high. Obviously, we go into medicine knowing we will be working with patients and that everything we learn is for our future patients. However, it is always a humbling experience to be reminded just how important it is to take our studies seriously – as if someone’s life depended on it…which one day, will be the case.