Highs and Lows

There are days where I feel so confident in my abilities and my future in medicine -- bring on the next patient, let me place an IV, let's do that pap smear-- and then there are days where I think "Oh, crap! I'm going to be doctor soon, what am I doing? A pap what?"

So here are few of my highs and lows over the last few weeks:

High: Taking a sexual history, doing a pelvic exam, pap smear, and STD test on a young female in the free women's clinic at Open Door.

High: Seeing a super friendly 50 year old male at OPEX and being able to provide health maintenance counseling. He had been diagnosed with melanoma and had focused on treatment for the past 5 years. Now that his melanoma was under control, he wanted to know what else he should be doing for his health. Being able to give advice re: immunizations, colonoscopies, EKGs, physical exams, and prostate exams = totally within the realm of things I can do.

Low: Learning how to do pelvic exams with standardized patients. Awkward contrived setting. Unsure of role (am I doctor or student? Is this women patient or teacher?). Conflicting advice from teaching doctor and standardized patient. Being corrected before having the chance to correct myself. Just...overall yucky feeling of incompetence.

Low: First physical exam under supervision of OPEX preceptor. Patient -- 26yo male coming in for yearly physical. Here is the thing...whenever I see patients close to my age, my confidence skips town. I feel like 7 year old playing doctor . The ease of taking a history slips away, the physical exam becomes a series of steps you have to memorize instead of a natural compliment to the history. Now, I didn't do terrible. I asked the right questions, I heard the regular rate and rhythm of his heart, I saw the clear tympanic membranes. BUT, it was uncomfortable. I know it, he knew it, and my preceptor knew it.

High: Knowing my crap about diabetic patient management and diabetic ketoacidosis in small groups this week. Maybe I do actually know something...

Becoming comfortable with the uncomfortable

Today we learned/performed the male GU exam. An important exam, no doubt, but an uncomfortable one for the patient as well as the doctor sometimes. The male GU exam involves examining the genitals, feeling for hernias, and doing a digital rectal exam to check the prostate.

It was a lot easier/less awkward than expected.

First of all, our standardized patient was fantastic. He was completely comfortable teaching us how to do a proper exam, and I think his comfort level put us all at ease. Any man that is willing to go through 8 consecutive prostate exams by first year medical students is someone who really cares about us learning for sure. It was really helpful to have instantaneous feedback regarding our exam technique (too much pressure, too little pressure, try a different angle, etc...)

Afterward, we had a "debriefing" session with the urologist where we discussed how to handle different patient reactions during the exam (he's had people get so nervous that they faint), which is also a really important aspect to think about.

I have to say, it is SO nice to have the first male GU exam out of the way-- probably one of the most awkward experiences is past.

P.S. Heading out to Haiti in 4 days -- so crazy!