i put on my white coat this afternoon for 4 hours, and i probably won't be wearing it again for another few years. strange. the reason i was wearing the coat was the 'cpx' exam, a simulated clinical evaluation required of all medical students here after the 2nd year is over. apparently, just 2 years ago it used to count, and people used to fail this exam, and they would have to take it over again in order to graduate. now, it's 'pass-pass'. meaning: even if you're the most insensitive, ignorant prick during the exam, you still pass. just for showing up. even so, i was still dreading the idea of spending 4 hours talking to patient actors. i'm not in doctor mode anymore. and 4 hours is a long time.
basically, the idea is that you see a series of 8 fake patient-actors, and a scenario card is provided outside the door of the room. for example:
"Miss Razzleberry is 7 weeks pregnant and wishes to discuss issues related to her prenatal care. Spend 10 minutes talking to the patient and 5 minutes providing patient education regarding the downside to smoking crack while knocked up. Then answer the questions provided outside."
so you go in there, and you do your thing. somehow, (perhaps because motivation was lacking?) i couldn't manage to spend more than about 5 minutes in each room, even when i tried to make small talk. then, after your fake 'doctor's visit', you answer some questions on a laptop outside the door.
sometimes, the questions are obvious ones:
'provide a differential diagnosis for the lady with the colicky right-upper-quadrant pain.'
other times, they questions are more picky, asking for details you should have obtained from the history, theoretically. such as:
'does the patient sleep with prostitutes?' and
'is her pain of burning character sometimes and gnawing other times?'.
you can either check 'yes', 'no', or (my favorite) 'did not elicit.' i had a lot of those.
needless to say, i did not enjoy this exam. it felt so disingenuous to wrangle up sympathy and kind words and smiles for these actors again and again. when i work with real patients, it feels so different. there's no need for carefully crafting a veneer of fake sincerity, because with real patients i am (for the most part) being real. and sincere.
when i go to parties and i don't know people very well, i usually get a face-ache from fake-smiling, like i used to get during my cheerleading days. real smiling doesn't hurt. down with cpx!