Sunday, March 30, 2014

Nervous About Going to the Doctor - A Patient's Story

image credit: cnn.com

About a month ago, a reader contacted me after he found a post I had written about a sensitive physical exam. I will be telling his story over the course of two or three posts, with all identifying information and writing style changed, in the hopes that it might help others out there who are dealing with the same worries that he had. Here is his first email:

Hello Sir, 

Sorry, but I really don't know how to address you. I happened upon your blog while on the internet and I think I can tell you my medical problem because, well, you seem to be frank and... genuine. I guess I feel more comfortable communicating this way due to the fact that you are on your way to being a doctor... I don't know. I'm just really embarrassed.


Here's my issue: I have never had a physical exam by a medical doctor. I am 56 years old and I know this is not a good thing. My father and uncle had prostate cancer and I have been told repeatedly that I need to get a medical check-up, but it's just that I am very nervous and maybe afraid about the whole thing. I really don't know what to expect...

I am embarrassed to be unclothed in front of another person, even a doctor. I don't know what will happen, like what he will say or do - just a lot of stuff like that. I don't even really know what to ask you... I guess - have you learned anything about how to help a patient like me? I know I've got to do it, but I am really stressed out...

Sincerely,
Thomas


I wrote this in response to Thomas, but it could really go out to anyone who is dealing with similar thoughts, emotions, and feelings of fear and nervousness about going to the doctor. So, if you're reading this because you're nervous about going to the doctor, pretend it's addressed to you:

Hi Thomas,


Thank you for telling me about your situation. I think that your feelings of nervousness and even fear are quite natural, given the circumstances. I can see how someone with a family history of prostate cancer could be nervous about the idea of getting checked out, especially as you have never had a physical exam before. I think it's okay - even natural - to be nervous about this kind of thing. I also think that it might be easy to let that nervousness grow simply by imagining things to be worse than they are likely to be.

And you're right - I'm not a doctor yet. As such, I cannot give specific medical advice. However, you're also right that it will be good to get checked out in the near future. Even though I am not a doctor, I can offer my opinion on what might be the best "first step," given your feelings about going to the doctor. Before I do though, it might help to have things explained from the doctor's standpoint.

Doctors are trained to understand that getting unclothed for an examination can be very scary for patients. Most of us understand that this is not something that is easy for a patient to do. Sensitive examinations like this require a certain level of trust between the doctor and the patient. Most doctors establish this trust with their patients over years of visits, and so when sensitive examinations come up, it's not quite so scary. The patient trusts the doctor.

So, I think what might be a good idea for you would be to find a doctor and ask to meet with him or her (whichever you think you might feel most comfortable with) for a preliminary examination. You can request to not have a prostate exam done during the first visit. This way, you can have a chance to establish a relationship with the doctor, and he or she can get to know you a little better before moving on to the more sensitive examination at a later date. If you meet with the doctor and don't feel that you would be able to come to trust him or her, you could always look elsewhere for another doctor that you like better. Also, if you would prefer to speak with the physician over the phone as a first meeting, you could explain this to the nurse when you call the office for the first time. A good idea for where to get started might be to ask around among your friends for which doctor they see, and if they like their doctor. No need to tell your friends anything other than that you're looking to find a new doctor. Who knows - maybe one of your friends or relatives sees a great doctor with whom you'd get along really well!

The most important thing in all this is your health - both physically and emotionally. Any good doctor will want you to be healthy in both respects, and will not sacrifice one aspect for the other. I think it would be good for you to speak openly with whichever doctor you choose about your history and your reservations about having the rectal examination done. Any good doctor will be compassionate and understanding about what you're going through, and they should work with you about establishing trust.

Once that trust is established, I think you will find it much easier to contemplate going forward with the exam. Trusting your physician enough to form a partnership with him or her in the preservation of your health will go a long way toward helping you with your nervousness. I respect you very much for taking the time to write to me about how you're feeling, and your doctor will respect you as well. I think it's very admirable that you are considering the necessary steps for the sake of your health, even though you might be feeling scared and nervous. When you do end up choosing a doctor that you trust, I think you may eventually come to find him or her to be a source of support, rather than a source of nervousness. He or she will help you come up with a good plan so that you and your doctor - together - can deal effectively with any health issues you may have. And who knows - maybe you'll get a clean bill of health and totally set your mind at ease!

Above all, remember that all doctors start out like me - someone who wants to do everything they can to help people like you be healthy. We want to support you, and we want you to feel safe as we do so.

Please don't hesitate to write back if you have anything else you'd like to say, if you have any more questions, or if there's anything else that I can do to help. Even though we don't know each other, I will always take the time out to do what I can.

Sincerely,

Justin


Thomas replied a few days later with a thankful and succinct response. I thought this would probably be the last I'd hear from him:

Mr. Justin,

I want to thank you sincerely for taking the time to answer my inquiry. Your explanations and insights really did help me. I am going to follow your advice and move in the direction of seeking a physician I can trust. You will be a very good doctor... Keep to your studies. You have a way of connecting with respect and understanding. Best regards - fortunate are those who will one day call you their doctor.

Sincerely,
Thomas


A month went by, during which time I thought about Thomas several times, but like I said, I never really expected to hear back from him. I just hoped everything went well. Earlier this evening, I was surprised to have the following letter pop up in my inbox:

Hello Mr. Justin,

This is Thomas here. A while back I emailed you about my concerns over having my first physical exam. You gave me a very informative and what I think was a genuine response. I am so glad I confided in you because your words gave me the confidence to find a doctor and have my first physical exam. 

I will readily admit that I was very anxious, and I am sure it was evident to my physician. However, he was exactly as you said a doctor should be when examining a nervous patient. He reassured me, and was courteous and understanding. You are wise beyond your years. You had told me that patients often imagine the physical exam to be worse than it is... That was me to a T, but now I am much more at ease now and I have been back twice to complete the physical exam. 

My doctor is going to take good care of me - certain tests for the prostate because of family history and lab work which he will analyze for various things... Well, anyway, I am sure you know all of this as you are a medical student, but I just want to say that you must keep the compassion and sensitivity that you have for people like me. 

Honestly, you really helped me tremendously, and you will be a fine doctor. I know this... You have compassion. Thank you, and do good in your studies.

Sincerely,
Thomas

---------------

I must admit, in the midst of the stress and occasional discouragement of studying for Step 1 and the next domain exam, it felt incredible to hear about Thomas' experience. It's great to have played a small part in helping someone. It feels pretty rare that we med students get to take a break from learning and actually do something. Helping people is one of the biggest reasons we started down this road in the first place, and it can be easy to lose sight of that behind the thousands and thousands of practice questions and textbook pages...

To any potential patients out there who are struggling with nervousness about going to see a doctor, I would recommend that you take heart from Thomas' experience and try to find a doctor with whom you're comfortable. After all, nearly every doctor was once a lowly med student just yearning to help people, so who knows - it might not be as bad as you think.

Wednesday, March 26, 2014

M3 Grand Rapids 1st Clinical Campus Meeting

MSU CHM Dean - Dr. Marsha Rappley
Med school is a very different experience from most experiences, but in its own way it's just like every other part of life. It feels like it's simultaneously flying past and d-r-a-g-g-i-n-g its slow feet across the gymnasium of time. It feels like both yesterday AND forever ago that I started M1 and had my White Coat Ceremony. I've had many PBL preceptors mention how much they'd love to be back in med school and "only have to learn." We always stare at them like they're insane, but I can understand how it will probably feel that way again. They always follow it up with some variation of, "I don't miss the tests, but I do miss the learning and lack of responsibility." I can see how, a few decades down the road, I might somehow eventually come to feel something similar. I like many aspects of med school, but I think I'm really going to enjoy being a practicing physician.

Anyway, yesterday things started "feeling real" in a new way. We had the first meeting for our clinical campus. At MSU CHM, you spend your first two years in either East Lansing or Grand Rapids. Half of the students are in each city. Then, we split up into one of six cities for 3rd and 4th years: Grand Rapids, East Lansing, Flint, Midland, Traverse City, or Marquette.

I'm staying in the Grand Rapids campus for 3rd-4th years, and like I said, yesterday we had our first meeting. We were oriented to how the next two years will work, focusing on 3rd year. Starting in July, we will be moving through different clinical rotations, called Clerkships. There are six core Clerkships, and an optional slot for an elective* (not in this order):

1. Family Medicine (8 weeks)
2. Internal Medicine (8 weeks)
3. Pediatrics (8 weeks)
4. Obstetrics/Gynecology (8 weeks)
5. Junior Surgery (8 weeks)
6. Psychiatry (4 weeks)
7. Elective Clerkship / Break (4 weeks)

*Starting last year (.: my class will be the second ever) they also allow us to take an elective clerkship. We have to take 4 elective Clerkships between 3rd and 4th years, so if you take one in 3rd year, it essentially opens up a month of free time in your fourth year. I plan on taking one during 3rd year, making 4th year that much more awesome. I have some specific interests that I plan to use this as an opportunity to pursue, so I'm pretty excited about the idea.

Everyone is split into smaller groups, and we rotate through the clerkships in a specific order, everyone in their groups. Because Michigan State College of Human Medicine is a community-focused med school, we also rotate through many different hospitals. I might be assigned to a hospital in downtown Grand Rapids for one Clerkship, then transfer to a hospital in a more rural town 45 minutes away for another clerkship. I'm looking forward to the variety of experiences that we'll get when we're exposed to different settings of practice. I'm still not sure if I want to practice in a big hospital in a city or a smaller hospital serving a more rural community, so this will be pretty eye-opening for me.

Before then though, I have to do well in all my classes as well as Step 1. Gotta keep my eyes focused on what's in front of me... Hard at times, but necessary.

As always, hope you've enjoyed reading.

Tuesday, March 25, 2014

Cardiology Domain = DONE

photo from wellingtonregional.com
Yesterday, we took the Cardiology Domain exam. It was a 3-hour exam (116 questions) covering 4 weeks of information spread out over 5 weeks (thank you, Spring Break Blitz!). It was a beast. I now feel pretty confident in my basic knowledge of how the heart functions, and most of the basics on what can go wrong and the (very basic) functionality of the drugs used to treat those conditions. Hopefully this knowledge will stick with me at least until June (when I take Step 1). Opinions in my class were fairly 'unified' regarding the quality of the exam itself and how good of a job it did representing the high-yield topics that we learned over the past few weeks. Since this is a public blog, I think I'll leave it at that...

Regardless, Cardio is over now, and we're on to MER - Metabolism, Endocrine, and Reproductive systems. We only have two domains left until the end of M2, and then it's on to the ISP to get ready for Step 1. I can't believe it's almost here. MER, Gastrointestinal, and then Step 1. Awesome.

To celebrate the end of one more Domain, Wife (who has apparently forsaken the blog world) and I went out to a movie last night, then came home and relaxed with some quality time together. I slept in this morning - a luxury which I haven't experienced since Cardio began - but now it's time to buckle down, muscle through, gear up, hit the books, get back in the saddle, put my ear to the grindstone, kick it, and think up more cliches.

Anyway, thanks for reading, and wish me luck!

Friday, March 7, 2014

Seeking Michigan = Awesome Video .: Nostalgia.


Video credit to Eric Hines Photography

Special thanks to my younger brother for clueing me in to this video. He shared it in nostalgia, as he lives across the country and occasionally misses Michigan (despite all the awesome mountains and snowboarding he experiences). I live here, but studying so much sometimes makes it seem like the wonders of Michigan are worlds away.


Nostalgia Abounds.

Wednesday, March 5, 2014

Update on My Future - Shadowing and Specialties

Source: A Cartoon Guide to Becoming a Doctor: Choosing a Medical Specialty
I still haven't decided on a specialty. I did some more shadowing today in the Emergency Department, this time with a third year resident who is getting ready to finish things up in June. It was a great time shadowing. While I still feel like I know almost nothing in comparison to actual doctors, it no longer feels like I know nothing, as it did just one year ago.

I now recognize drug names (sometimes) and conditions (most times). While I might not be able to rattle off the six most common causes of acute headache that could possibly be urgent in nature, I know what they're talking about when they mention temporal arteritis and why you look for an elevated sed rate. I also understand when the doctor explains that an elevated sed rate is very sensitive for temporal arteritis, but not very specific.

While I don't immediately know the best possible breathing-assistance apparatus to use to help someone with obesity hypoventilation syndrome, I can now look at a blood gas panel and identify that the patient is experiencing acute respiratory acidosis and whether or not it has been partially compensated by renal bicarbonate retention. I know what to listen for when the doctor finds something in the patient's lungs and asks me to note my findings.

One of the coolest things about today's shadowing is that, since I've started the Cardio domain, I can do some limited interpretation of EKG results. While to many docs it's simply old-hat, to me it's still new, and kind of fun to be able to look at a tracing readout and know something about the patient that nobody had to tell you. I can quickly determine heart rate and readily note abnormalities. For example, today a patient's EKG had an abnormally inverted T wave. This can mean a variety of things, but given the patient's clinical presentation, I had an idea of what it might mean.

The 'transformation' is my blog's namesake is happening. I can feel it. I am noticing things during patient examinations and understanding the differential diagnosis discussions far better than I would have thought possible after less than two years in med school. I have a long, LONG way to go yet, but I can see myself doing this job more and more clearly these days. Like I said earlier, I'm still not 100% set on Emergency Medicine, as some aspects of other specialties (specifically Internal Medicine (after all, Hospitalists and Emergency Medicine physicians share a lot) and Surgery (who doesn't like procedures??)) are really attractive to me. However, I'm slowly coming to realize that I could be very happy in a wide variety of specialties, and that's encouraging. The world doesn't hang on one specific specialty for me, and that is relaxing in a way.

Today wasn't the most productive in a Step-1-studying kind of way, but it was really good for me in a future-outlook-and-stress kind of way. Tomorrow will be more geared toward UWorld Questions and board studying, but for today, it was fun to just think about the future. Also, tomorrow I start the West Michigan Therapy Dog program with the first of eight classes. Hobbes won't be joining me for this or the next one, but dogs come to class starting the third week, so that'll be fun.

All right, time to be done with this post. Thanks for reading, and feel free to comment below or use the Contact Me portion of my blog to send your thoughts, complaints, or words of encouragement. Have a great day!

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