Anxiety during physical exam

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The new guy

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I did my first pelvic exam on a patient last week. The attending was in the room and talked me through it. Afterwards he basically told me I sucked, that I seemed really nervous and that I lack confidence. I thought that was probably true but kind of harsh...isn't that to be expected? This isn't just me, is it? I was worried I was going to do something terrible and render the patient infertile for life.

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You're not going to make someone infertile with a plastic speculum and an attending over your shoulder.

It's normal to be nervous when you're doing something for the first time, but you should be confident in yourself and try not to let it show, because patients will pick up on it.
 
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You're not going to make someone infertile with a plastic speculum and an attending over your shoulder.

It's normal to be nervous when you're doing something for the first time, but you should be confident in yourself and try not to let it show, because patients will pick up on it.
I didn't think I let it show. Maybe I looked even more nervous than I actually was.

Also I was kidding about the infertile part. Mostly I was just worried about screwing up or hurting the patient. I've never had a pelvic exam (I am a male).
 
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The fact that you are posting about it tells me that you need to man up and stop being so sensitive. You think you're going to give a patient a heart attack by auscultating their chest or something? The patient was probably like "is it in yet?"
 
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The fact that you are posting about it tells me that you need to man up and stop being so sensitive. You think you're going to give a patient a heart attack by auscultating their chest or something? The patient was probably like "is it in yet?"
Lol. I don't mind doing a heart exam but this seemed so...invasive
 
I'm pretty sure being nervous while doing your first pelvic exam is literally the most typical thing any medical student could ever encounter.
 
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As invasive as asking a person about the most personal details of their life including drug use, sexual habits, family history of deaths, medical maladies? As physicians we have contract with society where people trust us with their lives and open up the most intimate portions up to us so that we can help them. Just touching a stranger is incredibly invasive. I was very uncomfortable with my first physical exam. But soon you'll have your hands inside people during an operation or picking out a baby from a vagina and these little things don't faze you anymore
 
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i just practiced a ton with your mom.
 
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If your not nervous the first time you do an invasive exam, your may be a sociopath. (Which as it turns out is not mutually exclusive with being a successful physician)
 
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We have been fortunate to have special instructors come in and let us practice the invasive pelvic exam stuff on them as they taught us. I only did the male one so far, but I was amazed at how much we could push and prod without hurting the individual (the level of sensitivity of course varies person by person). But, it helped me get over that fear of hurting the patient a bit, cause the instructor literally told me it wasn't hurting as I was doing the exam, and encouraging me to be less afraid.

Basically, I think it takes more to discomfort the patient than we think (still, early on, it's probably best to err on the side of caution). Anyhow, just keep at it! You're definitely not the only one that's nervous with these exams. Doing my first breast/pelvic exam on a female next week, and I'm nervous too. Just trust that you'll get more comfortable and better over time.

Heck, I even get slightly anxious when I have to check the point of maximal impulse on a female patient. I think it's just a matter of, the more you do, the better you get at it.
 
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We have been fortunate to have special instructors come in and let us practice the invasive pelvic exam stuff on them as they taught us. I only did the male one so far, but I was amazed at how much we could push and prod without hurting the individual (the level of sensitivity of course varies person by person). But, it helped me get over that fear of hurting the patient a bit, cause the instructor literally told me it wasn't hurting as I was doing the exam, and encouraging me to be less afraid.

Basically, I think it takes more to discomfort the patient than we think (still, early on, it's probably best to err on the side of caution). Anyhow, just keep at it! You're definitely not the only one that's nervous with these exams. Doing my first breast/pelvic exam on a female next week, and I'm nervous too. Just trust that you'll get more comfortable and better over time.

Heck, I even get slightly anxious when I have to check the point of maximal impulse on a female patient. I think it's just a matter of, the more you do, the better you get at it.
Physician prostitutes? I'm getting moonlighting ideas.
 
Physician prostitutes? I'm getting moonlighting ideas.

At our institution, I believe you get a $10 check for allowing 4+ medical students to examine your rectum for the male GU exam. Something about that whole situation just made me feel a little icky.
 
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I've heard its actually pretty lucrative at my place
 
At our institution, I believe you get a $10 check for allowing 4+ medical students to examine your rectum for the male GU exam. Something about that whole situation just made me feel a little icky.

At my school you get paid $900 I think.
 
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Yeah at my school it was supposedly 150 bucks for an afternoons work. The patients didn't guide us through the exam though. That post made it sound like they were examining the instructors, which seems to up the awkward to a new level.
 
I think I'd be more worried/creeped out by the medical student who did NOT get nervous before performing his first pelvic exam.

My guess is the attending pointed out the reality that you were indeed nervous and lacked confidence. Welcome to the club. Keep practicing. You'll get better.
 
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At our institution, I believe you get a $10 check for allowing 4+ medical students to examine your rectum for the male GU exam. Something about that whole situation just made me feel a little icky.

I get the sense that we pay our standardized patients significantly more. Probably in the hundreds
 
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attendings/residents saying a student lacked confidence can be annoying sometimes. Especially as a third year, youre trying to juggle being humble/receptive vs coming off like a pompous jerk which can be very hard to navigate with the amt of other learning thats going on. I think the vast majority of medical students gain confidence when their knowledge and skills increase over the years and through residency with no problem. Unless someone is almost incapacitated from anxiety/nervousness then I think attendings/residents should just reassure them they will relax more as they gain more experience.
 
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It's okay to be nervous the first time! I'll never forget my first pelvic exam. The patient was having menses AND had Von Willebrand disease.
 
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I get the sense that we pay our standardized patients significantly more. Probably in the hundreds

Where I did school it was definitely hundreds. And they no doubt got some mileage out of telling their parents they help teach a med school course. Or feel that they are improving health care by teaching a new generation of med students the right way to do these exams due to a bad experience they had with their own doctors.
 
My first time doing the pelvic exam with a standardized patient, I pinched the cervix with the speculum on my way out. It was clamped there for about a full minute while we tried to get it to open back up. Bless her soul, the SP only barely winced and told me I did fine. This doesn't help OP but I just wanted to get it out there.
 
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