As I mentioned previously, one of the courses I take in medical school is the Arts and Science of Clinical Medicine (ASCM I) where we learn basic clinical skills. So far this year we learned to take patient history, vital signs (heart/respiratory rate and blood pressure), and some physical exams (precordial, peripheral vascular). Next semester we will learn more physical exams like neurological, abdomen, etc.

For this first ASCM exam, we were evaluated on taking patient history and vital signs. The basic outline of the exam was that you would work with either a standardized or real patient – take their history for up to 35 minutes, and then have the final 10 minutes for the vital signs. While this was going on, a physician would quietly evaluate us.

My scheduled exam time was 8:00 am. By 8:15 am I was the last student still sitting in the waiting room, waiting for my physician to come get me, worried that I was forgotten about or something.

Finally my physician comes out and says, “oh there you are, we didn’t know we had to come get you – we were waiting for you inside the room!” I chuckle in reply “Haha I was waiting for you too!”

So I walk into the room and the patient is already sitting at a chair – the physician asks me to take a seat across from the patient and begin the exam. I quickly grab some hand sanitizer and rub my hands together as I introduce myself to the patient. She has chest pain, and so I spend a few minutes asking her more about it. I then go on and ask her about her family history, past medical history, medications, allergies, habits, and social history.

I realize that this is going really quickly and she doesn’t have much information for me – it makes me start questioning whether I actually missed a question or something. Once or twice, I pause for a few seconds, trying to think if I asked everything. I’m pretty sure I did, but I’m a bit paranoid because it seemed to have gone by way too fast. I’m not too surprised though because my brother said his lasted only like 15 minutes, but of course, when you’re in the moment, it’s easy to over think stuff.

After having summarized her situation twice (lol, paranoid much?), I move on to the vital signs part of the exam. Heart rate: 64 beats/min. Respiratory rate: 16 breaths/min.

Just before I start the blood pressure measurements, oops, I remember: “Oh yeah, the heart rate was regular” lol. (this means the heart rate had a regular rhythm).

I put the blood pressure cuffs on the patient, no problem. I start by measuring her systolic blood pressure by palpation (i.e. palpating the radial artery in the wrist and determining the pressure in the cuff that it returns). I try it once, and realize as I release the pressure in the cuff that I’ve lost her pulse. No problem I guess, I apologize to the patient and tell her I need to do it again.

This time, as I pump up the cuff, I realize the cord is knotted. I try a few times and it’s still knots even after I unknot it.

“Sorry, this doesn’t usually happen” (honestly, it doesn’t, so it’s a bit frustrating that it happens during an exam).

“Don’t worry, it’s just a technical difficulty” says my doctor evaluator. I’m really happy at this point that I have a super nice evaluator.

I finally seem to have gotten the cord straight, and I go ahead and obtain her systolic blood pressure by palpation: 95 mmHg.

I then go on to use my stethoscope as well, placing it over the brachial artery in her arm, and listening for her systolic and diastolic blood pressures. This time everything goes well, no problems: 104/65 mmHg. Don’t know if that’s right, but there you go!

I thank the patient for her time, and the physician and I leave the room for a few more words. She asks me about my general observations of the patient, and I tell her that the patient looked comfortable and rested, but that she appeared a bit hesitant, maybe because she was seeing me from the first time or maybe from her concerns about her chest pain. I also note that she wasn’t in distress and she looked about her stated age, maybe slightly less.

The physician examiner tells me she doesn’t know if she’s supposed to give me my feedback right now, but she smiles at me and says, “but don’t worry, you did great!”

Which made me feel great because I figure if she’s going to say that, there’s no way she is going to fail me – that would be just way too cruel.

I wish I could take a nap, but I’m heading to the anatomy lab this afternoon (followed by a business meeting tonight), so I need to do some last minute studying of head and neck!

Have a good weekend everyone!