Standardized Patient

So this was actually kind of fun.

In 1st semester we made up imaginary interviews, based on imaginary patients. Yesterday, in pairs, this time we interviewed actual people acting as patients with imaginary problems. And of course, this is all leading to 3rd and 4th semesters when we'll start going out into the clinics, shadowing doctors, and taking a more active role with actual patients with actual problems.

What I initially wanted to do was to list all of the patient interview information as it was gathered, in the order that it was gathered and see how soon you could figure out a probable diagnosis for yourself. Unfortunately, I can't actually talk about the interview itself. Even though it was just an actor with imaginary signs & symptoms, the school was very clear that we all had to keep the information to ourselves. Instead I'll just keep it in vague terms.

Now the following will probably seem so basic to all the 3rd and 4th year students out there (as well as any current physicians), but the way an actual interview unfolds is really interesting. And I use the word 'unfold' intentionally in this case; based on the way it all the information comes together in the end as the details of a patient and their problems are slowly revealed.

Imagine the basic outline of any patient interview which includes the basic information (name, age, marital status, occupation), chief complaint, family history, past medical history, physical exam, and vitals (including height, weight, etc). The skeleton of the interview is nice but there really isn't anything to sink your teeth into until you get into the follow-up questions and scrape for more information in the review of systems. This is mostly because any single sign or symptom can be used in describing many different diseases and syndromes (which is actually the definition of a syndrome). But the point is that, at least from what I've seen, is that there's always that key bit of information that suddenly explains many of the problems the patient is having.

At first you're in the dark, gathering as much as you can. Next, you pick up on very unusual bits of information -- usually that have a very distinct onset within the patient's recent history -- that slowly raise flags. But even with those flags, the complete picture still isn't made clear. You kind of know there's something more, but you can't exactly put your finger on it. Although it's with these flags that direct your questioning and examining. And if you know the information you've learned in class and if you've asked the right questions during the interview, when that key piece of information shows its face, the light bulb goes off.

It's at that time when you revert strictly into lecture and your studies and your flashcards and lists. And you just go down the line of clinical presentations associated with that particular pathology. And if you're right, most (all?) the answers that come out of the patient's mouth after asking these very directed questions are exactly the answers you're expecting to hear -- but only if you're suspicion is correct.