How to act during an HPI?

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Did they not teach you Validation and Displacement?
 
southernIM said:
Poorly thought out screen name...I thought about changing it at one point but now it's kind of fun because everyone assumes I'm in medicine.
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I first thought you might have been someone who originally though he was set on IM, and then ended up going into Surgery. It's kind of funny bc your personality and the IM stereotype don't really go together.
 
Arkangeloid said:
So I got in trouble with the school admins after failing to take an HPI of a standardized patient properly. While the evaluation said that I had done everything correct from a medical perspective and covered everything I needed to cover, I failed because I "did not display the proper emotions or provide consolation" when the patient talked about sad ****. The evaluator remarked that I "did not show any emotion at all."

I was confused at this, because nobody taught me what to do regarding emotional ****. All my instructor told us was to "act like you are on a date," but that is meaningless to someone who has never been on a date.

So how are you supposed to act when taking a HPI?
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Honestly, this is something that is hard to do sometimes as a pre-clinical student. You have to treat the SP as a real patient and it will make empathy easier. Just talk about how whatever they are going through must be difficult, how you're here to help them fix whatever is wrong and get them back to wherever they need to be. We learned about it before we had to do a solo SP.

Acting like you are on a date is a horrible analogy, because hopefully your date is not telling you about her medical conditions (or other sad **** that would make you 'display' emotion). If you got the medical part right, good. You'll be OK, just BS it until you hit MS3. Once you hit MS3, you don't have to over-do the emotions, and there will be some patients that truly pull at your heart strings with their stories, and the empathy will (hopefully) come naturally.
 
sidefx said:
Obviously not when it comes to dosing your sildenafil 😱
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evilbooyaa said:
Honestly, this is something that is hard to do sometimes as a pre-clinical student. You have to treat the SP as a real patient and it will make empathy easier. Just talk about how whatever they are going through must be difficult, how you're here to help them fix whatever is wrong and get them back to wherever they need to be. We learned about it before we had to do a solo SP.

Acting like you are on a date is a horrible analogy, because hopefully your date is not telling you about her medical conditions (or other sad **** that would make you 'display' emotion). If you got the medical part right, good. You'll be OK, just BS it until you hit MS3. Once you hit MS3, you don't have to over-do the emotions, and there will be some patients that truly pull at your heart strings with their stories, and the empathy will (hopefully) come naturally.
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Well from my time here, I've found that potential dates are prone to questioning your knowledge of biochemical minutiae and will attempt to exam your oral mucosa.
 
Psai said:
Well from my time here, I've found that potential dates are prone to questioning your knowledge of biochemical minutiae and will attempt to exam your oral mucosa.
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Poor Anasto will never live down the Ach incident I think.
 
Arkangeloid said:
Actually my psychiatrist does suspect I have Asperger's based on a birth and developmental history, but she did not make a formal diagnosis of the disease, so I guess the answer is "no."
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OP, I feel for you. You are obviously smart and capable of learning the medicine. When you described your difficulties I, too, immediately thought of Asperger's.
The fact that you are asking for help after your faculty recognized a serious problem in connecting with patients at an emotional level is a marker of humility and a genuine desire to learn a skill that doesn't come naturally to you. It will be difficult but is not by any means unattainable, and will do wonders for your overall relationships in life.
You already have a psychiatrist--excellent. Ask him/her to help you overcome this problem. We know that empathy and reading nonverbal cues are difficult for those with ASD--but we also know that empathy CAN be taught.
Ignore the rude responses you have received and focus on the encouraging ones. Please discuss this issue with your therapist ASAP. It will be critical to your success in clinical education and your ongoing practice. You might read some of Temple Grandin's work too.
I wish you the very best.
 
DermViser said:
Assuming you're being serious, the key is to act more caring and empathetic. Perfect example: How would YOU want to be treated by a doctor, if you're seriously going to a doctor for help with a problem? Or how would you want a doctor to treat your own mother?

A doctor isn't just someone who spits out facts, information, and lab reports to the patient, esp. in this day in age where a lot of that can be Googled. It's not just throwing pills and procedures at patients. Yes, with a standardized patient it's hard to be empathetic as it's not real. Hence do what every student does here and at Step 2 CS, you act and fake it well.

On another note, congrats on getting the medical stuff right. That's the hard part, in my opinion.
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To be completely honest, I would want the doctor to avoid cliches and apologies and just help me with my problem. The goal isn't to treat the patient the way YOU want to be treated. The goal is to figure out how the PATIENT wants to be treated, which can be extremely variable. Some patients want you to avoid these kinds of topics except for what's absolutely necessary, and some want to discuss them at length.
 
tantacles said:
To be completely honest, I would want the doctor to avoid cliches and apologies and just help me with my problem. The goal isn't to treat the patient the way YOU want to be treated. The goal is to figure out how the PATIENT wants to be treated, which can be extremely variable. Some patients want you to avoid these kinds of topics except for what's absolutely necessary, and some want to discuss them at length.
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Being empathetic doesn't mean going into soliloquies.

If you were a patient who was undergoing chemotherapy for Hodgkin's lymphoma and let's say the side effects (alopecia, nausea, vomiting, etc.) are really taking a toll on you. Would you want the Heme/Onc doctor who doesn't give a ****, and tells you to suck it up? Or would you want the Heme/Onc doctor that is empathetic towards your concerns and understands how hard chemo is and acts accordingly?

The medical literature is quite clear regarding malpractice claims against doctors w/ and w/o empathy for the same treatment. Guess which one got sued less.
 
DermViser said:
I first thought you might have been someone who originally though he was set on IM, and then ended up going into Surgery. It's kind of funny bc your personality and the IM stereotype don't really go together.
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DERM why'd you change your profile pic? what does it represent? How noobs take physicals? or how much superior derm is to these IM idiots?
 
Priapism4tooLong said:
DERM why'd you change your profile pic? what does it represent? How noobs take physicals? or how much superior derm is to these IM idiots?
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Nope, just an example of a pediatric dermatologist truly enjoying her work alleviating skin disease of children and having empathy. Your profile pic is quite ironic considering your username implies an erection gone amuck.
 
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tantacles said:
To be completely honest, I would want the doctor to avoid cliches and apologies and just help me with my problem. The goal isn't to treat the patient the way YOU want to be treated. The goal is to figure out how the PATIENT wants to be treated, which can be extremely variable. Some patients want you to avoid these kinds of topics except for what's absolutely necessary, and some want to discuss them at length.
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Apparently we're in the minority. I've said many times I don't need my doctors empathetic or smiling; I need them confident, efficient, attentive to detail, AND correct.

I've seen stupidly dismissive doctors and that's something else altogether.
 
Priapism4tooLong said:
DERM why'd you change your profile pic? what does it represent? How noobs take physicals? or how much superior derm is to these IM idiots?
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Whatever it is, the previous one was better. I had to keep reminding myself that he doesn't actually look like that.
 
Anastomoses said:
Whatever it is, the previous one was better. I had to keep reminding myself that he doesn't actually look like that.
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😆 I'm alternating pics. The other one was to procedureish.
 
Anastomoses said:
Apparently we're in the minority. I've said many times I don't need my doctors empathetic or smiling; I need them confident, efficient, attentive to detail, AND correct.

I've seen stupidly dismissive doctors and that's something else altogether.
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Well if doctors aren't empathic more often we're going to get smoked by the NPs that "treat the whole person", so better put on a ****-eating grin and tell a patient how sorry you are that they sparked their CHF (again) by eating a cheeseburger (again) even though it's strictly forbidden from their diet.
 
Arkangeloid said:
So I got in trouble with the school admins after failing to take an HPI of a standardized patient properly. While the evaluation said that I had done everything correct from a medical perspective and covered everything I needed to cover, I failed because I "did not display the proper emotions or provide consolation" when the patient talked about sad ****. The evaluator remarked that I "did not show any emotion at all."

I was confused at this, because nobody taught me what to do regarding emotional ****. All my instructor told us was to "act like you are on a date," but that is meaningless to someone who has never been on a date.

So how are you supposed to act when taking a HPI?
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If you are not a troll - may god have mercy on your soul.

Seriously no offense, how did you get into medical school without the requisite social skills?
 
LostinLift said:
If you are not a troll - may god have mercy on your soul.

Seriously no offense, how did you get into medical school without the requisite social skills?
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"No offense," then you make a very offensive statement rofl.

To answer your question, God himself set me upon this path and got me into medical school, and He will see me through to the end of my training.


Also, I think it's cute that a premed dares to criticize, no, INSULT his seniors. Especially when you've never done a HPI in your life, let alone one on a SP that is recorded and scrutinized by a committee of examiners for every possible mistake.
 
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Arkangeloid said:
"No offense," then you make a very offensive statement rofl.

To answer your question, God himself set me upon this path and got me into medical school, and He will see me through to the end of my training.


Also, I think it's cute that a premed dares to criticize, no, INSULT his seniors. Especially when you've never done a HPI in your life, let alone one on a SP.
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Damnnnnnn Arkangeloid's got some bark in his voice.
 
Arkangeloid said:
God himself sent me to medical school, and He will see me through to the end of my training.


Also, I think it's cute that a premed dares to criticize his seniors. You've never done a HPI in your life, let alone one on a SP.
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More power to you I guess if you believe He will guide you. Also what makes you think I've never done an HPI? I have taken more HPIs than any first or second year, unless they too worked in a busy ED where the doctors were also Residency Faculty and had experienced scribes get the chart started and see the patient first.


Arkangeloid said:
Also, I think it's cute that a premed dares to criticize, no, INSULT his seniors.
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I think you need to take a step back and just read your own posts sometimes. Also this is the kind of attitude that makes dickhead attendings, please don't propagate that tradition..
 
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LostinLift said:
More power to you I guess if you believe He will guide you. Also what makes you think I've never done an HPI? I have taken more HPIs than any first or second year, unless they too worked in a busy ED where the doctors were also Residency Faculty and had experienced scribes get the chart started and see the patient first.

What's sad is that a pre-med can take a better history.
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If you have had as much exposure to medicine as you say you have, then you would know that people in medicine frown on grossly disrespecting your superiors. You should check your temerity before this fall, or be ready to enjoy several encounters with your Dean of Student Affairs.


I think you need to take a step back and just read your own posts sometimes. Also this is the kind of attitude that makes dickhead attendings, please don't propagate that tradition..
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I ask for constructive advice, and you come into this thread and (as a premed) tell me that I did not deserve entry to medical school when I had done you no wrong. Then you have the audacity to call me a "dickhead," and tell me to "read my own posts."

Seriously?
 
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Arkangeloid said:
If you have had as much exposure to medicine as you say you have, then you would know that people in medicine frown on grossly disrespecting your superiors. You should check your temerity before this fall, or be ready to enjoy several encounters with your Dean of Student Affairs.
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There's a big difference between grossly disrespecting your "superiors" and giving people some ****. Just like there's a difference between a brown nosing MS3 and one who can joke around and talk **** with his superiors. Unless the Resident and Attending have that same foolish attitude, they will appreciate the person who is real, yet appropriate. Though this is a social phenomenon with which you are probably inexperienced.

Seriously all joking aside I really do mean no offense, but a huge part of medicine is empathy, and you just have to understand how trolly some of your posts seem.
 
Arkangeloid said:
Also, I think it's cute that a premed dares to criticize, no, INSULT his seniors. Especially when you've never done a HPI in your life, let alone one on a SP that is recorded and scrutinized by a committee of examiners for every possible mistake.
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First and second year students always ask me how I studied during the preclinical years, and I tell them all the same thing: "How dare you speak to me."
 
boogaloo said:
First and second year students always ask me how I studied during the preclinical years, and I tell them all the same thing: "How dare you speak to me."
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Big difference between asking for advice and telling someone they don't deserve to study medicine (when that person, incidentally, asked for advice).
 
A lot of you are beating up on OP and I get it because of how he sounded but I honestly feel the same way at times. My last test had a standardized patient who came in with a psychiatric complaint when we didn't even have the psych module yet and it was just so ridiculous. I couldn't take it seriously as they were telling me about their fake problem about how they thought they caught a disease from someone. It's just acting in my opinion and I find it hard to pretend to care about someone's fake problems. I understand that empathy is important and I try my best in real life but I can't fake it for the sake of some stupid test. I am working on it though so I don't fail CS.
 
I find this strange, not in any time would my school criticise me for not having emotional resonance while doing a hp, as long as I do it in a respectful and professional way. I mean any kind of patient.

btw, all the patients I see are real. Didn't have any roleplay crap
 
Arkengloid I really think you are not telling the whole story.

"Act like you are on a date" I cant believe a doctor said that.
 
Kahreek said:
Arkengloid I really think you are not telling the whole story.

"Act like you are on a date" I cant believe a doctor said that.
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A doctor didn't say that, the guy teaching us to do HPIs (an MS4) said that. Maybe it helped him, I dunno.

(I hope he doesn't read this, because he knows who he is. If you're reading this, know that I don't blame you for what happened, and I thank you for all the help you have provided me. I wish you the best of luck in residency and your future career).
 
Anastomoses said:
Apparently we're in the minority. I've said many times I don't need my doctors empathetic or smiling; I need them confident, efficient, attentive to detail, AND correct.

I've seen stupidly dismissive doctors and that's something else altogether.
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Every patient is different. Their emotional needs are different.

Part of the skill acquired over time is figuring out which ones need what from you. I've alternately sat on the edge of the bed and held a patients hand while I explained some ish to her, and sternly/borderline paternalistically stood at the doorway and told others what the plan would be.

But...when you're talking OSCEs and SPs...you gotta drink the med school kool-aid that everyone should be a touchy feely empathic provider. "empathy" is a box to be checked in these situations.
 
you are not required to smile or pretend you are enjoying your date. I would go even further advice against too much smiling.
Maybe you were just lacking some eye contact and assertive interpersonal contact, as expected in any professional environment.
 
Anastomoses said:
Apparently we're in the minority. I've said many times I don't need my doctors empathetic or smiling; I need them confident, efficient, attentive to detail, AND correct.

I've seen stupidly dismissive doctors and that's something else altogether.
Click to expand...

Definitely not smiling. You might start closely examining their mucous membranes.
 
Winged Scapula said:
I am a "glass half full" sort of gal to be sure but youre assuming I don't know what he looks like IRL.
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I didn't know that attendings COULD be "glass half full" people. Except my old pediatrician and current psychiatrist, they all seem to hate life.
 
DermViser said:
Definitely not smiling. You might start closely examining their mucous membranes.
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Only if they offer a kiss. Then I would without hesitation.

Winged Scapula said:
I am a "glass half full" sort of gal to be sure but youre assuming I don't know what he looks like IRL.
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Well, I wouldn't expect you to faithfully represent his looks if you do know him in person. Do you?
 
DermViser said:
Gosh, your exposure to some attendings must be very limited.
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Mostly it's just a hospitalist who keeps ranting about how pointless her job is and how it's a waste of time to treat her patients, who'll be back in the hospital in a bit anyways. I was interested in IM before that (mostly as a gateway to its subspecialties), but after meeting her, combined with the knowledge that at the rate I'm going I won't be competitive for those subspecialties, I'm having second thoughts.
 
Arkangeloid said:
Mostly it's just a hospitalist who keeps ranting about how pointless her job is and how it's a waste of time to treat her patients, who'll be back in the hospital in a bit anyways. I was interested in IM before that (mostly as a gateway to its subspecialties), but after meeting her, combined with the knowledge that at the rate I'm going I won't be competitive for those subspecialties, I'm having second thoughts.
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Yeah, Hospitalist is not the best role model. The ones I've noticed who do like it do so 1) bc of the pay, and 2) getting every other week off (which you need to recuperate). A small minority actually like the intellectual breadth of hospitalist medicine. Hardly a way to approach life, so early on for a med student.
 
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DermViser said:
Yeah, Hospitalistis the worst role model. The ones who do like it do so bc of the pay, and getting every other week off (which you need to recuperate). A small minority actually like the intellectual breadth of it. Hardly a way to approach life.
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I'm not even sure in which thread it would be appropriate to address the new photo. Seriously, you didn't even let the paint dry on the last one.

Is it true they don't allow short bald guys into derm?
 
Arkangeloid said:
I didn't know that attendings COULD be "glass half full" people. Except my old pediatrician and current psychiatrist, they all seem to hate life.
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That's too bad. What's to hate?

I had a great day in the office, everyone was happy and doing well. One of my favorite reps, from Genomic Health, stopped by to say hi and even brought me a Starbucks NF Soy Iced Chai. It was warm and sunny so I dropped the top on the car for the ride home. I found a Chloe purse 60% off at Nordstroms. Had a fun dinner with friends and ate some delicious falafal. Now the cat is sleeping on my toes while I look at my schedule for tomorrow.

Whats there to be miserable about? I have a great life; it's not perfect but it's pretty darn good.
 
Anastomoses said:
I'm not even sure in which thread it would be appropriate to address the new photo. Seriously, you didn't even let the paint dry on the last one.

Is it true they don't allow short bald guys into derm?
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I picked the photo for you actually. 🤔
 
Anastomoses said:
I'm not even sure in which thread it would be appropriate to address the new photo. Seriously, you didn't even let the paint dry on the last one.

Is it true they don't allow short bald guys into derm?
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They do. They're called attendings.
 
Kahreek said:
Arkengloid I really think you are not telling the whole story.

"Act like you are on a date" I cant believe a doctor said that.
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I still can't believe that doctor told the lady with lumbar lordosis that she just has "ghetto booty".
 
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