Let's Play Doctor!

Really, it was good and it was so much fun!

Today I had my first mock-patient-interview at the McGill Simulation Center. Basically, McGill Medical School has hired a bunch of actors who pretend to be different patients, with various personal profiles, medical conditions, social / psychological issues, etc, so that doctors and nurses-in-training can practice doing the standard medical interview in a simulation before doing it on real people. Good chance to hone bedside manner, as well as learning how to get the critical information efficiently and effectively to better serve our future patients.

How it worked for us today:

• Stand behind closed door for 1 minute and read the paper with the patient's name, age and very basic profile (mine was "Phil Wilson is a 21-yr old law student")
• Then there's a voice that comes over the loudspeaker telling you to go in -you have 8 minutes to conduct the interview.
• The voice comes back on the speaker letting you know when there's 2 mintues left
• Once time is up or if you finish before, 2 of your peers who have been watching you through a double-sided mirror and listening to you with headsets, join you and the actor who was your patient in the room.
• You say how you think it went, your peers say how they think it went, and then the actor gives you probably the most important constructive feedback since they really know about all this from doing it all the time.
• Then each of your peers has a turn with a different patient, and you get to watch them on the other side of the double mirror (creepy, but effective).

It was amazing. Felt so real. And we all know I'm a bit Type A so I had prepared a little. Lots of it (and especially today because as first year med students, let's face it, we know very little medically-speaking) was really about whether or not we could draw out a narrative from the patient from a physical, social and personal perspective -"whole person care" -and make them feel comfortable and like they could trust us -"bedside manner". So I had written down a few lines on how I would go about my questioning in a logical and flowing manner: start with introducing myself, then ask the patient how they prefer to be called, then ask them what brought them into the clinic or hospital that day. Let them talk uninterrupted. Then back-track: when did it start? how much pain? where? the quality of the pain? how often and how frequent? anything that made it feel better or worse? what did the patient think may have caused it? Then go into the patient's medical history, medications, allergies, family history. Then ask them about their personal life, stressors, social life, occupation and (wait for it...) their sex life (gah! this last question remains the most uncomfortable / difficult one for me to ask).

K. So I had rehearsed all this in my head about 3 times before going to the SIM Ctr. And I was all professional in my shirt and tie. And I was sweating over whether I would get the most difficult patient-type ever, which for me would be the 'seductive patient'. You know that male patient that hits on you, makes you feel uncomfortable, asks inappropriate questions... I was like, "Please give me the crazy cranky old lady" or the pathological liar, or the hyper-active child... just not the sexy one who hits on you (it's worse if they are hot because if they are not, it's easier to more directly say things like "this is not appropriate" etc... otherwise I am bound to just passively ignore the flirtation a la "if i pretend it doesn't exist, then it doesn't exist").

And I mean today proved the following: I didn't get the 'seductive patient', but I definitely still got the young, very attractive patient, and I could not for the life of me ask him about his sex life (the closest I got was "so how are things in your personal life?"). Now actually, the fact that he was good-looking was not so bad because luckily he wasn't sooooooooooo hot that it was a distraction preventing me from focusing on my job. In fact, I got lots of positive feedback from the actor and my peers regarding professionalism, friendliness, putting the patient at ease / making him feel comfortable and that he could trust me, not being judgmental, sympathizing with him, reassuring him without making any false promises, etc... The actor even said that making him feel comfortable and not judged was really key since he was a young guy and I was a young woman doctor and he was embarrassed about his condition, but felt comfortable telling me more details about his symptoms, etc. But still, I failed on the 'difficult questions' front (i.e. sex and illicit drug use). You see, the fear of the seductive / attractive patient is actually a rather separate issue from the "tell me about your sexual activity"-question phobia. I don't know why I have such a hard time asking about this, even after telling myself "you're the almost-doctor, you're allowed to ask these questions, you need to ask these questions to help your patients" and even after hearing the actor say, "you're the doctor, you have the power, so don't be afraid to ask those difficult questions about sex and drugs, etc... because you need to know about it and patients will be okay telling you about it".

Still, I guess this is a hang-up I just need to work on. "What has your sexual activity been like lately? Do you sleep with men, women or both? Do you use protection? How many sexual partners have you had?" These questions are all inappropriate in a non-medical context when talking to a complete stranger. Put the white coat on and it's okay. Well, for me, right now, it doesn't quite matter yet whether I think "white coat" or "purple hat" or "pink slippers", I'm still just me, getting all up in their business and asking them about sex, sex, sex. Don't get me wrong, it is a fascinating topic for conversation, for reading, for writing, for movies and TV (don't we all hold our breath for that hot scene in "Cold Mountain", or "Sex and the City" or "Grey's Anatomy", or even Dagny's dramas with her lovers in one of the best novels of all-time, Atlas Shrugged, whose main theme, you should know, is not sex, but the sex is very lovely-ly depicted) and for euphemizing. But I'm sure I must have turned six shades of blush, just asking my faux-patient "how his personal life was going". What's wrong with me? We're not 12 anymore, you know.

You know, maybe it's because medicine is so existential though -like if you do anything wrong, even something that's a relative 'nothing' can become a matter of life and death. And sex must be the most ultimate expression of being alive in a sense, right (okay, fine, as a caveat, I guess we can also admit than any passion for that person is also the ultimate expression of their life energy)? And if illness can sometimes be almost-death (okay, fine, caveat #2, suffering may be the only way we know we're still alive and passionate and not dead...), then when your patient comes to you worried sick about their ability to express other forms of their aliveness -being able to go on with their life, in their occupation, in their studies, in sports, in moving from place to place, in their many other kinds of relationships -and then you ask them about how it is for them when it comes to expressing the ultimate act of aliveness, do you really want to hear that the problem or the sickness or debilitating-ness lies in the sex? Isn't this why STDs and STIs are so particularly scary? Because the act that should be the ultimate expression of life can be a death sentence, the ultimate tragic irony?

But maybe I'm philosophically way off too. Maybe I am just euphemizing again (and I do this quite well, so don't be fooled people). Maybe sometimes we're just 12 and we're in denial about it.