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Playing DoctorOh, no! I'm the first patient these 23 medical students have ever examined.

By Emily YoffePosted Wednesday, July 4, 2007, at 8:33 AM ET

Emily Yoffe was online July 5 to chat with readers about this story. Read the transcript.

Over the course of three days recently, I had 23 head-to-toe physicals from 23 second-year students at the Georgetown School of Medicine. I was the first person these would-be doctors had ever fully examined on their own. Some were shaking so violently when they approached me with their otoscopes—the pointed device for looking in the ear—that I feared an imminent lobotomy. Some were certain about the location of my organs, but were stymied by the mechanics of my hospital gown and drape. And a few were so polished and confident that they could be dropped midseason into Grey's Anatomy.

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Georgetown allowed me to be a "standardized patient"—that is, a trained person who is paid $15 an hour to be poked and prodded by inexperienced fingers, so that med students can learn communication and examination skills before they are sicced on actual sick people. In Human Guinea Pig, I try things you might want to do but don't have the time or opportunity. However, even if you had the time or opportunity, you probably wouldn't want to be examined by 23 medical students.

The concept of the standardized patient has been around for decades, but only in recent years have medical schools made training with them a regular part of their curriculum. I talked to a 50-ish physician friend about my experiences, and he said when he was in medical school and it was time for the first rectal/genital exam, the students were told to pair off and examine each other. "So, do you pick someone you like, or someone you don't like?" he recalled. "Either way, it's lose-lose."

Now there are standardized patients trained for genital duty (they're called GUTAs, for genitourinary teaching associates), but I signed up for something less invasive. Mine was the simplest possible assignment. I was to sit on the edge of a padded table in one of those awful, flapping hospital gowns, in a room equipped with recording devices in the ceiling. Each doctor had 30 minutes to conduct a standard head-to-toe physical: from my vital signs, to my nerve function, to my reflexes, etc. Then I was to go to a computer and check off whether they'd done all 45 parts of the exam ("Palpated for fremitus," "Auscultated carotids"), and write my comments on their bedside manner.

There are some obvious things you hope no doctor ever says to you, but on this assignment, I discovered there are a few others:

"I have to admit I have some butterflies."
"I've never felt anyone's liver."
"I'm so sorry! Are you all right?"

I actually was charmed by the students who acknowledged their nervousness, and it was adorable the way most of them would stop after finishing one body part, look upward as if at a floating textbook, mumble some mnemonics, then continue the exam. Before he left the room, Dr. K (although they can't yet call themselves "doctor," I'll call them that here; they're so eager, they deserve it) ran his eyes over me and said, "Let me check if I forgot any major systems. That would be bad." But nervousness in a doctor can be dangerous. Dr. F had a relationship with her instruments that reminded me of Edward Scissorhands. She apologized profusely after stabbing me with the otoscope.

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Emily Yoffe is the author of What the Dog Did: Tales From a Formerly Reluctant Dog Owner. You can send your Human Guinea Pig suggestions or comments to .

Illustration by Robert Neubecker.

COMMENTS

Remarks from the Fray:

Just reading this column made my blood run cold and my nerves get all shaky.

Ugh. I hate having to go to doctors. I try to avoid the experience as much as possible. If I ever get a dread disease and then hear these wretched words from a doctor: "if only you had come in sooner it might have been possible to save you" I will know I have only myself to blame. I guess.

What makes this column so readable is how concerned and even nervous most of those doctors were toward Emily. I found that to be endearing in the sense that a patient is still a new experience for them and an experience that most of them seem to be in awe of, almost. It's heartening.

Many experienced doctors have a sort of tired, even annoyed attitude if you give them any "trouble" (ie: you don't lie there like a passive non-entity who does not ask questions that are too complicated while they examine you like a machine).

I think this attitude is changing. But managed care also imposes restrictions on doctors in terms of how much time they can spend with a patient and I think that impacts on how hurried and distracted a doctor may come across, as well.

--Mara5525

(To reply, click here.)

I worked as a phlebotomist at a teaching clinic, a health care clinic affiliated with a hospital where young doctors fresh out of med school do their residencies. There were about 20 residents, most between the ages of 20 and 27, and 5 supervising doctors, most of whom had been practicing for upwards of 25 years. Overall, working with the inexperienced doctors was a fantastic experience: they were cautious and methodical, careful not to miss anything, they were open to suggestions and willing to ask for help from their colleagues, and they didn't treat non-doctors like crap (which happens all too often in the caste system of the health care industry). Most of the residents made efforts to acquaint themselves personally with each patient, and often remembered the patient's name the next time he/she came in. I would highly recommend seeing a resident doctor, if only to help them learn or because it's significantly less expensive--it's a valuable experience for doctor and patient.

--teddygram85

(To reply, click here.)

This article nearly brought me to tears. As an overworked second-year resident only three or four years from the medical school experience described, it's pretty easy to forget that there are lay people, potential patients, actually out there rooting for me. In general I feel undervalued, underpaid, and looked on with undue suspicion at this point in my training. Thanks Ms. Yoffe, for reminding me that I'm here to do a good thing, and that sometimes people are pretty understanding of that!

--Kelton528

(To reply, click here.)

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