Can you blame me?

So my medical school, like most medical schools (I assume), has a class to teach doctoring. You know, all the stuff a doc needs to know and do that doesn't get covered in anatomy and physiology and those sorts of courses. Stuff like interviewing patients and doing physical exams. And even though most of us treat this as sort-of a not-class, in that it's not as intellectually demanding as, say, pharmacology, I actually quite like it. Don't get me wrong, I like hard science too, but it's nice to have a class to think about the people side of medicine.

Anyway, this year (year 2 of med school), in Doctoring, they are starting to stress differential diagnoses, so that's what we were working on at our first small group session a couple of weeks ago. And as part of this practice, I was performing a physical exam on a standardized patient who (fictitiously) had pain in his right elbow. We learned basic physical exam skills last year, but not really any focused skills. In this case, apparently, I needed to do a joint exam, and in my original attempt to pinpoint the location of the patient's pain, I gently touched his elbow and said, "Is this about where the pain is?" And he replied, "Well, it doesn't hurt now; you're being so gentle." So I laughed and replied smilingly, "Well, I don't want to make the pain worse," thinking that this must be the right sort of thing to say and do.

But no! I got mildly scolded by our group leader (an Internal Med resident), who told me "It's okay to cause pain." Which, I guess I understand. After all, we've already gotten the lecture on how Hippocrates' "First, do no harm" couldn't possibly be followed literally by any doctor, or surgery (and may other fields) would not exist. I guess I felt that in this case, there was little reason for me to even come close to causing this man pain, since I was not going to be offering him any sort of treatment based on my findings anyway. Furthermore, he was a standardized patient (an actor, basically, for those not familiar), so I didn't think I would have been able to find anything interesting even if I did examine more thoroughly.

Thinking about this episode, I hope this is the kind of doctor I end up being. I don't mean it literally, as I'm sure I will end up being more aggressive with physcial exams like this. But I hope I stay the kind of doctor who errs on the side of not causing more pain, the kind of doctor who can't put out of her mind that the physical exam may be uncomfortable for the patient, the kind of doctor who remembers what it's like being a patient.