Ow my leg!

I spent yesterday morning being a patient for the 3rd years for their practise clinical examinations. I had to lie on a bed and pretend to have a DVT and they had to take a brief history from me and examine my leg in just 5 minutes. The task was actually pretty straightforward and most people did fine, but I could tell that they were pretty nervous about it.

The interesting part for me was to be on the other side of the stethoscope and be able to watch how they conducted themselves. I learned that little things in what doctors do can make a huge difference to the patient's perception of them. I knew this before of course, but seeing 12 people do the same task in different ways in one morning really emphasizes the point.

Weird things that people did that I found really off-putting included:

• not introducing themselves to me,
  
• having their hands jammed in their pockets while talking to me,
• leaning against a wall or chair while talking to me,
• not warning me beforehand when squeezing my supposedly painful leg,
• not looking me in the face when squeezing my supposedly painful leg and hence missing my NIDA inspired grimaces of agony,
• looking up at the roof and saying, "ummm, what else?" when they were stuck for a moment (everyone got stuck at some point - the good people just didn't talk about it out loud)

Since DVTs cause the affected leg to get hot, I was supplied with a heat pack which I applied to my leg before the students came in to examine me. Most of them checked my legs for differences in temperature, but since they knew I was just pretending, they didn't expect to actually find any physical signs, so only one student all morning noticed that one of my legs was hot. (Actually I think both of my legs are hot, though perhaps a little hairy.) He looked up at me in surprise and said, "I don't know how you've done this, it's very clever, but the affected leg is much warmer to touch". Everyone else just skated past it, saying that both legs were the same temperature. The examiner would ask them at the end to go back and check my legs again - it wasn't until they were specifically directed to compare temperatures (obviously indicating that something was going on) that they noticed it. Then they would get all quizzical and I would say, "ha-HA!" like a stage magician and show them the heat pack that I had thrown under the bed as they walked in. To their credit, they all laughed.

I certainly learned a few lessons of what not to do, which I will hopefully be able to put to good use next week, when I have to do a respiratory examination on a standardized patient of my own. It's hard to imagine someone deliberately filling their lungs up with fluid just to trick us, but at least now I'm aware that I need to report what I find, not what I expect to find. Good bit of learning, that.