Tuesday, November 29, 2011

Learning to be a doctor: the physical exam

Over Thanksgiving, our daughter was home from her first three months of medical school. She's had an intense schedule: 7 weeks of anatomy followed by 1-2 weeks each of biochemistry, cell biology, metabolism, pharmacology, and genetics. When Leo and I were in medical school, each of these was a sedate course that met daily for a quarter, a semester, or a year. That allowed a chance to review, connect, and ponder. This sounds like a mad sprint of memorization, unlikely to linger in memory. We tell our daughter that's okay, because anything you really need to know in medicine you'll learn a few more times before you're done.

Much more exciting is the fact that she has begun to learn physical diagnosis. For us, examining patients didn't come until the second year of medical school. Carrying the tools of the trade--ophthalmoscope, otoscope, little rubber hammer, vibration fork, little Snellen eye chart, and most of all, the iconic stethoscope--that's when you really begin to feel like a doctor, or at least a legitimate apprentice in the guild of medicine.

Rhianon spent all weekend practicing elements of the physical exam. I can assure you that my mental status is good and stable, since she checked it daily. Apparently my peripheral vision is a little blurrier than she feels it should be, because I could never tell how many fingers she held up. (I think she held her fingers too far to the side.)

On Monday, we finally got replacement parts for one of our old ophthalmoscopes so we could examine each other's retinas. Rhianon has trouble with this because she's not good at closing just her right eye. (I never knew about this disability during her childhood. Neglectful mother, I noticed that she could wink without ever remarking that she could do so only on one side. It is not sophisticated to have to cover your eye with one hand.)

Whichever eye she used, Rhianon had difficulty seeing the blood vessels at the back of the eye. I tried to walk her through it, but it's like describing how to ride a bicycle. First of all, it comes so naturally that it's hard to break down the steps. Second, words can be a pretty inefficient way of explaining movement. Showing is so much better.

By dinnertime, not only Rhianon and I but also my husband and son were seeing yellow and purple spots on our washed-out retinas. Rhianon was beginning to get the hang of it. We just told her there's plenty of time and hundreds of hours of practice ahead of her before doing a physical exam becomes a flexible, natural activity that can help her understand a patient's story.

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