Emily Yoffe was online at Washingtonpost.com on Thursday, July 5, to discuss her adventures as Slate's Human Guinea Pig, the latest of which involved being examined by medical students. An unedited transcript of the chat follows.
Washington, D.C.: If they can't tell you if something was wrong, how did you know they missed "something nasty"?
I'd ask what it was, but ... nah.
Emily Yoffe: I meant I'd hate to find out after all my exams that I'm not in perfect health -- especially since I was told I had good mucosa and good bowel sounds.
Arlington, Va.: Thank you for the wonderful article. The Human Guinea Pig is my favorite series of articles. I sent this one to a friend who just started her internship at the Mayo Clinic. I hope it makes her laugh as much as I did!
Emily Yoffe: Thanks so much. I have heard from several medical students who said they recognized themselves and their classmates (the nervous laughers, the deadly with instruments, the smooth operators).
New York, N.Y.: I'm also a med student, and really enjoyed your piece. Though the standardized patient has become a big part of medical school (at least at my school), there are still some things we practice on each other for the first time—most notably drawing blood. Just be glad your physical didn't include any lab work....
Emily Yoffe: I don't think I would have signed up for 23 blood samples—I'd have to call the column Human Porcupine. As a patient, it's clear being able to draw blood requires a certain talent that not every medical professional has.
You're right, the standardized patient is becoming standard in medical schools, as the schools address the question of how to better develop doctors' communication skills.
Washington, D.C.:"My beagle, thank goodness, is too incompetent to hurt a little bunny." Careful, that's what I always said about my mildly retarded (but very sweet) cat. I was shocked speechless when he dispatched a mouse in the basement and laid its little corpse at the foot of my bed.
Your next gig should be in the janitorial industries. I'm curious about what people throw away, and what sorts of things they tuck under their desks.
Emily Yoffe: Good idea! I'll look into it.
Northeast, Washington, D.C.: Emily—thanks for volunteering to be a standardized patient. My wife just graduated from medical school and I'm glad she had people to practice stuff on besides me. I was surprised by the age of many of her classmates—many were not fresh out of college, having chosen medicine as a second career. Did you notice any difference in the manners of the soon-to-be doctors in relation to their age?
Emily Yoffe: You're a good husband. Hope you now get excellent, free medical care.
Most of the students looked about the same age—very early twenties. One guy seemed a little older and he was great—very skilled and not at all nervous. I did want to ask him what he'd done before medical school, but I wasn't supposed to break into my journalist mode.
Philadelphia, Pa.: My fiancee just finished her second year of med school, and I've noticed that the population of her class seems to be equally split between the half who, grading on a gentle curve, seem normal, and the half who are definitely aliens. (I recently had the experience of watching at a bar as two second years who must be from Neptune mimed out the female pelvic exam with their fingers in the air. Very gross, though bizarrely hard to stop watching.) What I've always wondered is whether the roughly normal group are actually better at doctoring than the weirdos. Among the would-be doctors who examined you, were basic social skills a good proxy for who did a good job and who did a dreadful job, or was there something else that made them successes or failures as physical examiners?
Emily Yoffe: Interesting and disturbing observations about your fiancee's classmate, because all of them will have a white coat with M.D. stitched on it.
But we've all had doctors whose personalities seemed, well, defective.
There seemed to be a general correlation between good social skills and eye contact and examination skills. But some really awkward ones actually did fine when it came to examine me.
Bethesda, Md.: Hi. This piece is great. I graduated from med school eight years ago and at that time we only had standardized patients for the male (urology) and female (gyn) exams. It was a great way to learn how to do a proper and thorough exam. My two "patients" were a nurse anesthetist (the man) and a midwife(the woman) so there was no BS-ing either one of them. The woman gave hints about how to make the examinee more relaxed during the exam ... talking to the patient the entire time you are examining her to let her know exactly what you are doing. Even though I now work in a different part of the body, I talk to my patients about what I am seeing the whole time. As a patient, I hate that silence while a doctor is looking and then that painful pause between the end of the exam and when they tell you what's up. Enjoy your exams and thanks from those of us that you are training.
Emily Yoffe: Thanks and excellent points about talking. Maybe not every patient likes it, but I really appreciate when a doctor says, "I'm feeling for your liver" etc. I'm fascinated that an M.D. has a critique about how other doctors go about their examination.