Patient Contact

[humabot]

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I had a lot of patient contact during first year, but was extremely bored when it came to asking patients questions about their chief complaint and other relevant info for the History of Present Illness and Review of Systems. I like learning about science and disease, but the whole patient thing bores me to death. Is there any hope for the coming years? I mean, I came in liking patient contact, but then once I spoke to patients, it was the same thing over and over again. Anybody else feel this way?

humabot

 

[PeepshowJohnny]

Yes, there's hope. You can go into a specialty who takes more "focused" histories such as surgeons and avoid specialties like psychiatry and general medicine. Also, there are fields like Radiology and Pathology, which have essentially no history taking but considerably less "patient contact" (pathology more than radiology).

Also, schools tend to be kind of excessive on what they expect you to do for your H&P's when they're teaching it to you (one of our clinical medicine instructor told use if we weren't spending at least two hours with the patient, we were doing it wrong, yuck). So as this gets relaxed and your history is more manageable, you'll enjoy it more.

 

[pincheeric]

Plus, as an MS1 you don't really know how to conduct an interview efficiently. Most of the time these patients already have diagnoses, so you don't feel like you're doing anything to add to their care, and half the time you end up not even knowing much about the disease they have. Until you start to really appreciate the various medical problems the patients have you'll be stuck asking the silly (and almost never asked) questions about spirituality and sexual preference. I remember from the first week of 1st year seeing a patient with Barrett's Esophagus and having NO CLUE what that was and what questions to ask. That's normal. You'll learn more and the interviews will actually become valuable to your learning. Once you get to the point where you can see a patient, think "This guy has COPD," ask him "Do you get winded when you walk a block?," and have him say "Yeah, how'd you know?!"--then you'll see the value in the interview.

 

[GreenShirt]

Yes, there's hope. You can go into a specialty who takes more "focused" histories such as surgeons and avoid specialties like psychiatry and general medicine. Also, there are fields like Radiology and Pathology, which have essentially no history taking but considerably less "patient contact" (pathology more than radiology).

Also, schools tend to be kind of excessive on what they expect you to do for your H&P's when they're teaching it to you (one of our clinical medicine instructor told use if we weren't spending at least two hours with the patient, we were doing it wrong, yuck). So as this gets relaxed and your history is more manageable, you'll enjoy it more.

LOL, 2 hrs....has this guy heard of OSCEs?

 

[PeepshowJohnny]

LOL, 2 hrs....has this guy heard of OSCEs?

The OSCEs at our school are reasonable, set up like Step II CS.

But for our "complete" H&P's which we are assigned to go to the hospital and do on our own time, some of the instructors can be very nitpicky.

"I see you said he had a tetanus shot in the last ten years. But what was the actual date?"

"I don't see any mention of measuring the diaphragmatic excursion. Why was this not done?"

 

[MR1]

Totally agree about the excessive nature of H&P's during your 1st 2 years of med school. It does get better, as a resident a H&P I tried to keep under 15 minutes if possible and was usually able to for routine stuff, even shorter most times.

Also yes if this does continue to bore you look into more focused specialities, that is one thing I love about ophtho is not much HPI involved and although we need to know PMH it is not near as involved as with internal medicine.