18 Stethoscopes, 1 Heart Murmur and Many Missed Connections

[KUNRD07]

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http://www.nytimes.com/2011/03/01/health/views/01cases.html?_r=1&ref=health

 

[LizzyM]

Beautiful. Thanks for bringing this to our attention.

 

[courtnes]

Great article! Definitely something to think about heading into med school and clinical experiences.

 

[Zhuge Liang]

Average article. Care about people, don't treat them like objects, etc. It's all been said before.

 

[Geneticist]

Very nice article

 

[pinkynotbrain]

Average article. Care about people, don't treat them like objects, etc. It's all been said before.

Said, but clearly not often heard. And on some level, we hear so rarely from the patient perspective that a reminder from the other end of the stethoscope can have an effect that a hundred reminders from med school professors won't. We're trying so hard to remember everything we have to do (stethoscope the right direction? placement? what am I hearing?) that we may forget the things we should do, like treating our patients like people rather than collections of body parts.

 

[Zhuge Liang]

Said, but clearly not often heard. And on some level, we hear so rarely from the patient perspective that a reminder from the other end of the stethoscope can have an effect that a hundred reminders from med school professors won't. We're trying so hard to remember everything we have to do (stethoscope the right direction? placement? what am I hearing?) that we may forget the things we should do, like treating our patients like people rather than collections of body parts.

This sounds like something from a trailer to a movie about medical students.

 

[PSU2013]

Average article. Care about people, don't treat them like objects, etc. It's all been said before.

Its all been said before yet people are not practicing the message thus it needs to be said over and over again until people start.

 

[eli20]

Average article. Care about people, don't treat them like objects, etc. It's all been said before.

The way things are said is important too, I'm getting the feeling you missed the point.

 

[Nafisa]

Very nice article

 

[Barcu]

Meh. Not to be too negative, but this article didn't really convince me of anything (and the writing style )

While I agree that med student-patient interaction needs improvement, I wonder if this author went in with expectations that were too high. This author volunteered to let 18 students listen to her heart noises. Was she really expecting to be treated like a patient by each one of these students? Honestly, if a doctor asked me to volunteer for this, I would expect exactly what happened. And I wouldn't have really cared.

Edit: And I know students are supposed to treat these situations like real patients. But do people who volunteer this stuff really expect that?

 

[LizzyM]

Meh. Not to be too negative, but this article didn't really convince me of anything (and the writing style )

While I agree that med student-patient interaction needs improvement, I wonder if this author went in with expectations that were too high. This author volunteered to let 18 students listen to her heart noises. Was she really expecting to be treated like a patient by each one of these students? Honestly, if a doctor asked me to volunteer for this, I would expect exactly what happened. And I wouldn't have really cared.

Edit: And I know students are supposed to treat these situations like real patients. But do people who volunteer this stuff really expect that?

They hope to be granted the respect due any human being by another human being and not to be treated as a lump of flesh exhibiting an interesting click or pop. Some students seem to instinctively "get it" and some don't but try and come across as creepy, others ignore the person and focus on the pathology.

Ironic that so much is made of this at a time when some bemoan the loss of physical exam skills and an undue focus on diagnostic testing.

 

[Barcu]

They hope to be granted the respect due any human being by another human being and not to be treated as a lump of flesh exhibiting an interesting click or pop. Some students seem to instinctively "get it" and some don't but try and come across as creepy, others ignore the person and focus on the pathology.

Ironic that so much is made of this at a time when some bemoan the loss of physical exam skills and an undue focus on diagnostic testing.

I do see what you are saying. I think I just responded to the article how I would respond to the situation myself (as the "patient"). If some doctor wanted to show me off to patients, I would agree, and I would not really expect them to treat me any better than a cool case. I'm not really a patient per se. Saying something mentioned in the article like "how do they survive with this" or whatever would be crossing a line. But I wouldn't really expect the med students to each come up to me one by one and pretend like we're doctors and patients meeting for the first time. Maybe that's just me.

In most other situations, I would expect med students to treat any patients (or standardized patients) like they are human beings. But it was this specific situation that produced that lukewarm reaction in me.

And I thought the writing was a bit too sentimental. That may have contributed to me not responding positively as well.

 

[apumic]

They hope to be granted the respect due any human being by another human being and not to be treated as a lump of flesh exhibiting an interesting click or pop. Some students seem to instinctively "get it" and some don't but try and come across as creepy, others ignore the person and focus on the pathology.

Ironic that so much is made of this at a time when some bemoan the loss of physical exam skills and an undue focus on diagnostic testing.

I would think a lot of this comes from experience and role, don't you think?

I know my first [clinical] job in a hospital setting, I felt slightly awkward w/ pts and it took some time to become confident and able to shoot the breeze w/ a pt while getting a manual set of vitals, listening to the heart and lungs, getting a history, etc. These were 4th yrs, so I'd expect better out of them; however, I remember my first time shadowing a doc after working in the hospital setting for awhile was a bit awkward. If he introduced me things felt decent but it was always weird being the 3rd wheel in the room with no real function. I could see where students might initially feel a little weird listening to someone's heart as an example and, truth be told, I suspect that, assuming enough time in a clinical setting (say 1000-2000 hours), we've probably all said (or at least almost said) inappropriate things in a patient's room and then been like "oh cr*p!" (not aloud!) and wished we could retract the inappropriate question/comment. That all being said, I suspect it helps to introduce the students individually.

On a side note, I've seen this occur w/ a variety of other students -- EMT, nursing, etc. Just tonight, I watched as a couple of nursing majors attempted IVs on a pt w/o ever saying as much as "hello, my name is ______." I don't recall the RN ever really introducing them to the pt or staff, either, come to think of it. It was more like a quick "hey, girls, which of you wants to start his IV?" when the doc left. The poor guy got to be their pin cushion w/o so much as a "Hello," it seemed.

 

[kcin]

This woman sounds like a complete bitch. She's bad mouthing medical students who are completely uncomfortable in their new found role. She calls some of them creepy and makes it intentionally harder for them to hear the noise. What a bitch.

I don't really expect anything better to be published in that rag of a newspaper though.

 

[raltima07]

I would think a lot of this comes from experience and role, don't you think?

I know my first [clinical] job in a hospital setting, I felt slightly awkward w/ pts and it took some time to become confident and able to shoot the breeze w/ a pt while getting a manual set of vitals, listening to the heart and lungs, getting a history, etc. These were 4th yrs, so I'd expect better out of them; however, I remember my first time shadowing a doc after working in the hospital setting for awhile was a bit awkward. If he introduced me things felt decent but it was always weird being the 3rd wheel in the room with no real function. I could see where students might initially feel a little weird listening to someone's heart as an example and, truth be told, I suspect that, assuming enough time in a clinical setting (say 1000-2000 hours), we've probably all said (or at least almost said) inappropriate things in a patient's room and then been like "oh cr*p!" (not aloud!) and wished we could retract the inappropriate question/comment. That all being said, I suspect it helps to introduce the students individually.

On a side note, I've seen this occur w/ a variety of other students -- EMT, nursing, etc. Just tonight, I watched as a couple of nursing majors attempted IVs on a pt w/o ever saying as much as "hello, my name is ______." I don't recall the RN ever really introducing them to the pt or staff, either, come to think of it. It was more like a quick "hey, girls, which of you wants to start his IV?" when the doc left. The poor guy got to be their pin cushion w/o so much as a "Hello," it seemed.

I agree - i would think that the more you practice, the better you get. This is why shadowing is so akward

 

[AlexB]

This woman sounds like a complete bitch. She's bad mouthing medical students who are completely uncomfortable in their new found role. She calls some of them creepy and makes it intentionally harder for them to hear the noise. What a bitch.

I don't really expect anything better to be published in that rag of a newspaper though.

This. She doesn't realize these are students, and so what is she doing judging and literally making it harder for some students to examine her? If anything, I think she's creepy for recording the entire experience and then playing back Ben's voice over and over.

 

[raltima07]

This. She doesn't realize these are students, and so what is she doing judging and literally making it harder for some students to examine her? If anything, I think she's creepy for recording the entire experience and then playing back Ben's voice over and over.

Lol definately true

 

[Zhuge Liang]

Its all been said before yet people are not practicing the message thus it needs to be said over and over again until people start.

Or maybe a different approach needs to be taken? If something doesn't work after you've done it 1000 times, perhaps you are doing the wrong thing. Maybe writing articles like this is useless for improving the attitude of doctors/med students.

In my opinion, the writing was average at best and did not evoke anything especially notable emotionally. In fact, the author came across as some entitled prick that made the training harder for the students that lacked social skills. You're a volunteer, if you are going to be an ass don't volunteer. Again, these are students and this person expects them to be seasoned docs with perfect bedside manner.

Also off topic, but I think science writers in general need to improve the quality of their work. Many times you hear stuff on CNN and they choose the dumbest goddamn stories to talk about.

The way things are said is important too, I'm getting the feeling you missed the point.

Yes I agree and this writer failed horribly at communicating her point, which is anecdotal and probably bulls***. Anything written in an over-the-top omg revelation-esque way is probably 90% bulls*** anyways.

 

[LizzyM]

Note:
Madeline Drexler, a science journalist in Boston, is the author of “Emerging Epidemics: The Menace of New Infections.”


Note as well that if a patient is rubbed the wrong way, the patient can make things difficult for you. Most won't admit it or know how to do so efficiently but patients who know, and who feel the need to be punative, will do so.

Finally, this is not a "standardized patient" which is more often someone (often an actor) who is used for the purposes of testing examination and history taking skills.

 

[FlowRate]

Man, people always wanna hate on HMS as if it says "look the 'Best Medical Students' in the world still suck. Doctors suck." and after that, you might get "Be better."

Also, I thought it was actually a little strange that she found a shoulder-touch creepy. Some people try too hard to be creeped out IMO. Shoulder is like the standard "professional business touching" location, at that...

 

[startswithb]

Sounds like she volunteered to get an article out of it (which is why she recorded it). So, she had to put a spin on the experience somehow. And, being in the NYT, it had to err on the negative side if it was portraying doctors. 🙄 Really, it was just melodramatic. I somewhat appreciate the sentiment, though.

 

[RogueUnicorn]

Man, people always wanna hate on HMS as if it says "look the 'Best Medical Students' in the world still suck. Doctors suck." and after that, you might get "Be better."

Also, I thought it was actually a little strange that she found a shoulder-touch creepy. Some people try too hard to be creeped out IMO. Shoulder is like the standard "professional business touching" location, at that...

a little too long, she wrote.

 

[LizzyM]

Man, people always wanna hate on HMS as if it says "look the 'Best Medical Students' in the world still suck. Doctors suck." and after that, you might get "Be better."

Also, I thought it was actually a little strange that she found a shoulder-touch creepy. Some people try too hard to be creeped out IMO. Shoulder is like the standard "professional business touching" location, at that...

It wasn't the shoulder touch -- it was the length of the shoulder touch.

 

[Zhuge Liang]

Everybody* knows the shoulder touch should be is 1 second soft pressure, 2 seconds resting, medium pressure, and 1 second decreasing pressure as your hand leaves the shoulder. Do not forget to smile or the patient will not tell you crucial info that may save their life.


*minus those idiots at HMS

 

[MilkmanAl]

Man, Ben really nailed it. I'll be sure to tell all my patients that their conditions are "awesome" from now on. I have to be honest; I hate articles like this one. I grow very tired of the "If only doctors treated me like a person!" touchy-feely BS that ceaselessly finds its way into newspapers and med school curricula across the country. There's no question that being around someone with exceptionally poor social skills is a serious downer in any environment and that it sucks doubly when they're in charge of your health care. That said, does anyone really believe for a second that the author's mood varied so drastically from student to student? Maybe she felt awkward at times, but does she not understand that examining patients for the first few times is beyond awkward, too? Add in the facts that the people for whom social interaction doesn't come naturally are trying desperately to seem confident and that listening for heart pathology is just plain hard, and you have a disaster in the making. Considering that med schools make a business of training people who value academics above all else, you're not working with much from the start. Do they think these 20-somethings who are forced to bury themselves in endless tomes of facts for 2 years are going to magically become suave and personable because of a couple ICM lectures and patient encounters? The whole thing is a joke. If you want sociable doctors, admit sociable people to med school. Duh.

 

[LizzyM]

The whole thing is a joke. If you want sociable doctors, admit sociable people to med school. Duh.

Doin' what I can, MilkmanAl. Doin' what I can.

 

[MilkmanAl]

Fair enough. 👍

 

[XeReX]

Very nice article

👍 on Class of 2018!

 

[bucks2010]

Maybe the article is slightly embellished. I would argue that it makes it more readable & accurate. Any appointment with a physician can be an emotional experience for some. The writing may accurately convey what she really felt - who here can judge that?

And I think it's by no means a stretch for her to expect to be treated like a human being. So what if you've never heard the particular murmur before - is it too difficult to introduce yourself like any polite human being would? There will be a lot of firsts with patients in your medical career - will you be cold and timid like this during all of them? Seems to me that medical training is not just about learning to diagnose the pathology but also to put the pt at ease while doing so.

 

[KUNRD07]

Maybe the article is slightly embellished. I would argue that it makes it more readable & accurate. Any appointment with a physician can be an emotional experience for some. The writing may accurately convey what she really felt - who here can judge that?

And I think it's by no means a stretch for her to expect to be treated like a human being. So what if you've never heard the particular murmur before - is it too difficult to introduce yourself like any polite human being would? There will be a lot of firsts with patients in your medical career - will you be cold and timid like this during all of them? Seems to me that medical training is not just about learning to diagnose the pathology but also to put the pt at ease while doing so.

Couldn't agree more. What happened to manners and social interaction 101?

 

[LRAccord624]

Maybe the article is slightly embellished. I would argue that it makes it more readable & accurate. Any appointment with a physician can be an emotional experience for some. The writing may accurately convey what she really felt - who here can judge that?

And I think it's by no means a stretch for her to expect to be treated like a human being. So what if you've never heard the particular murmur before - is it too difficult to introduce yourself like any polite human being would? There will be a lot of firsts with patients in your medical career - will you be cold and timid like this during all of them? Seems to me that medical training is not just about learning to diagnose the pathology but also to put the pt at ease while doing so.

Easier to say than do. Sometimes you get so focused on what you're supposed to do, what you're looking/listening for, and trying so hard not to screw up that you forget you're actually examining a real person.

I had this same problem when I started learning to do the physical exam... I felt awkward... wasn't sure of the "right way" to ask certain questions or the best way to palpate a woman's PMI or a patient's inguinal lymph nodes. As I practiced it all over and over again, however, I was able to concentrate more on the patient and less on the procedural things, because they became second nature (are slowly becoming second nature, anyway).

Anyways about the article... I had conflicted feelings about it.

I liked this article purely because it was a reflection of many of my experiences these past few months. One SP allowed many of us to take turns learning how to do an ultrasound on her... halfway through my turn I realized I was rubbing a lubed up probe around this woman's abdomen before I even knew her name! We ended up having a good laugh about that and a great conversation, and she definitely taught me a lot.

However, I think the author is being pretty hypocritical. She is criticizing the medical students (future DOCTORS omg) for not putting themselves in the patients shoes (during a known learning experience), but she is doing the same thing! She never thought one time what it would be like as a medical student, early on in their career, probably feeling as if they know nothing but are expected to know everything. And be confident and charming all the while. Tough role to fill and it doesn't happen overnight for most people.

 

[motomed]

The whole thing is a joke. If you want sociable doctors, admit sociable people to med school. Duh.

Amen. Just like med schools talking a big game about meeting the needs of the populations they serve, more urban and rural primary care docs and all that, and then turning around and admitting every gunner from the suburbs with good numbers that applies....

I don't think it's a coincidence that med schools fall in love with numbers and fail to see the applicants and then we get articles about med students who see conditions and fail to see patients.... hhhmmm.....

 

[nlax30]

I was also like, "meh". Actually, I got to the end and was looking around for a page 3 link as it just seemed to end a little odd, to me at least.

 

[The right Path]

Note:
Madeline Drexler, a science journalist in Boston, is the author of “Emerging Epidemics: The Menace of New Infections.”


Note as well that if a patient is rubbed the wrong way, the patient can make things difficult for you. Most won't admit it or know how to do so efficiently but patients who know, and who feel the need to be punative, will do so.

This. In most cases it is most likely to be subconscious- it is natural to recoil from a creepy person.

I don't get why there is such a defensive reaction to the author. The purpose ofher article isn't to be critical of medical students or doctors. Her article illustrates that interpersonal skills make a difference in the effectiveness of a clinician. Believe it or not, the level of cooperation (intentional or subconscious) makes a big difference. It also affects how forthcoming a patient is about important information as well as compliance.

 

[ridethecliche]

It is completely shocking to me how self serving some people on here are.

It doesn't matter that she volunteered herself. She's a human involved in clinical interactions with medical students. How is that not a physician-patient interaction? No one's hating on Harvard. Calm down.

The article goes to show how depersonalized medicine is becoming and why the physical exam is fading and becoming more awkward for physicians to perform.

I'm guessing Dr. Basgoz here would agree.
Food for thought: http://www.npr.org/templates/story/story.php?storyId=129931999