I have not posted lately because I am attempting to be be less cynical and judgemental as I speed my way to the big 30 milestone. Everything I consider posting just sounds bitter and judgemental lately (for example why is it that medical students, a group of people that all profess to be concerned with helping mankind, can only do generous things that will be put on a resume or CARMs application or used for class credit?) so I have been practicing the Thumper 'if you can't say something nice don't say anything at all' philosophy.

One thing that has come up for my consideration this week is what it is to be a Standardized Patient.

We learn physical exam in groups of 5 with a clinician preceptor (we are assigned 2 that we alternate between) and a SP in the medical skills area that is set up like a clinic. Both of our preceptors are rheumatologists and excellent teachers, but that is where the similarities end. On Monday we had a session with preceptor one. She is a pediatric rheumatologist; warm, exuberant and eternally sensitive. We had a great session, if a little superficial in content, with a youngish female SP where we spent a great deal of time doing respiratory exam. Thoughout the session preceptor one talked directly to the SP, made sure she was draped properly and at the end asked how the session was for her, if she had been comfortable. It was a comfortable experience for everyone.

On Wednesday we had a cardiac session with preceptor two. It started out badly; two of the people in my group and the SP were late because the roads were terrible. It went downhill after that. The SP turned out to be a rather larger young woman. The preceptor had requested a male but the med skills, for good reason, do not honor these requests. We are just as likely to get a female on our exams and need to learn how to do cardiac exam under all circumstances in practice as well. The preceptor was at all times respectful, but far from sensitive. Because of her extra girth we could not see a JVP, feel a PMI and hearing heart sounds was even difficult. It was an uneasy experience for everyone. I, and all the other members of my group, tried to make her feel as comfortable as possible, but our preceptor was evidently disappointed that we didn't have a better subject.

One of the people in my group later commented that he couldn't understand why she would subject herself to the experience knowing that she would be exposed and examined given her extra weight and that she was so obviously uncomfortable. I think that a great deal of the situation would have been diffused if the preceptor had shown sensitivity to the degree that preceptor one had demonstrated. On the other hand we practice on SPs for a reason. They are not in the vulnerable place that real patients are; they are not sick, they are not depending on us to fix them or give them answers. They are being paid to be there so that we can use them as living models. However, we are also learning to be physicians and demonstrating respect for the people that are in our care is a really big part of our training. We can't start thinking of our SPs as meat puppets rather than as people or we might be tempted to think of or patients as a collection of symptoms or diseases instead of people as well.