The patient exam(Oral Practicum)
The misdiagnosis - learning to lead with your heart
There is so much to learn in PA school in a short amount of time. It has been referred to as medical school packed into 2 years - an analogy of drinking out of a fire hose.
Beyond testing the learning of each organ system and the associated disease processes and presentations, we are occasionally tested based on an actual patient encounter. An opportunity for our teachers to improve our bedside manner, communication with patients, and review our diagnosis and thought processes. Our program has a faux medical clinic which appears everything like a real office. From the waiting room to the patient rooms it appears like a typical new medical clinic. Our patient experiences are filmed, reviewed, critiqued, and ultimately made available for us to watch. The patients are paid actors who are given instructions to follow. Charts are on the front door and we aren't aware of the chief complaint until we get to the door. After the encounter we have a professor (doctor) available to whom we present the case as typically done in the medical field.
Yesterday I completed my second patient encounter exam. I made one key error in the diagnosis of the patient and realized the mistake immediately. I was so frustrated with the partial misdiagnosis... I know better. However if these tests are really supposed to be learning experiences I think that it was a success as I learned. There are a few mistakes that I would never do again based on this patient encounter.
This type of test is a difficult test to prepare for. The limitless possibilities of potential chief complaints and associated pathologies eliminates the idea of cramming to prepare. Consistant study and knowledge prepares you. The key advice I would give is to think clearly. Avoid regret by thinking clearly about what you are doing. You know what to do, trust you knowledge, trust your feelings and make the appropriate decisions. Look at the patient, use appropriate learned techniques for a physical exam, and don't be fooled by obvious possibilities but rather be confident and clearly think about what is wrong and what you are doing. You are always allowed to step out of the room while seeing a patient. As you step out of the room I recommend stopping and thinking about the complaint, the situation and quickly making sure you are thinking everything through. A good time to step out of the room is when you ask the patient to change into a robe and sit up on the exam chair.
I could go on for a long time but again my advice is this: USE YOUR HEAD BUT LEAD WITH YOUR HEART!! I believe as you do this you will have clarity and wise decision making.
