There comes a time, in fact several times, in a medical student’s career, where your heart sinks in a consultation. Often when you realise: The Patient Has Been Lying to You (less melodramatically-they're not a very good historian). Your Super Cool Utterly Self-Assured Resident (or SHO or Reg), whose first word was probably “psychosomatic”, asks you to see a patient, take the history, report back, and then you’ll go and see the patient together.
The dialogue goes something like this:
SCUSAR: So Jane, I understand you’ve been feeling a bit low since your boyfriend split up with you?
Jane: No we didn’t split up, we just had a really big fight, but it’s OK now.
SCUSAR: I see. And you’ve been feeling very down for about a month now, but not had any thoughts of suicide.
Jane: Actually I did think about it quite a bit, but decided I had too much good stuff in my life to do it.
At which point, a third party enters the dialogue, my internal voice, let’s call it Voice in Head.
VIH: Jane! You’re making me look bad! I look like either a) I got the details wrong when I reported back to SCUSAR, or b) worse, I forgot to ask the question. I asked you the exact same question and you said, no, you hadn’t had any thoughts of suicide.
SCUSAR: And I believe there’s no history of psychiatric problems in your family?
Jane: Actually my uncle has depression.
VIH: I wonder if this is what it’s like to be a parent when your kid starts screaming and throwing things in the supermarket...
SCUSAR: I see. And you work as a travel agent?
Jane: Yes, I do.
VIH: Yesssss! Thank you, Jane.
SCUSAR: OK, great, well thanks for talking to us today Jane. Before we go, is there anything you’d like to tell us we’ve forgotten to ask?
Jane: Yes. I have a rare condition which means I’m completely unable to tell the same story twice….
5 comments:
ROFL!
Totally wasn't expecting that at the end, good post.
I appreciate your frustration and embarrasment MMM, but a glance from the other side might be worthwhile: a differenct perspective can help.
On my last admission I had to tell various social workers, doctors and nurses from primary care, crisis care and the hospital what had happened to me and why I was in crisis. Seven times I had to tell the story. I knew some fo the staff (had even worked alongside one of the docs), I had different levels of trust with each on, different levels of anxiety, and as the whole process took about 12 hours and each professional had a different role, my priorities about what to say to each one were in a constant state of flux. There weren't 7 different stories, there was the same story told in 7 different ways, each of which was appropriate to the moment and to the mix of people present. And not one porky pie passed my lips throughout. BTW, this was one of my smoother, less fraught, admissions to a psych unit.
Just pray that it doesn't happen when you're presenting a bit of history you've taken for a mini-ACE presentation!
Sorry jan, I do understand, it wasn't really a comment on the patient (I have been a patient too, I know how easy it is to forget things that you remember later), more a humourous take on my fragile medical-student ego!
I know the patient isn't lying per se, although I have heard a medical student once say the patient was 'lying', which I thought particularly insensitive of him, as lying requires intent . It's stressful being put on the spot, answering a lot of really personal questions again and again, and you're right, feelings and emphasis change.
It was meant to be funny more than anything else, but perhaps I should have been a bit more sensitive :-/ Apols.
Your apology is appreciated but unnecessary, MMM. I was appealing to you to see things from the other side, and you're clearly well able to do that. I enjoy your posts. It's been strange for me, and educational, to work within a clinical team as a person who's experienced mental health problems. Working in this field is hard, and my admiration for those who choose to has grown, even though I'm more vocal than ever when I believe people have done a crap job.
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