clinical skills post#1

Today I had a clinical skills class. Now the purpose of these classes is to provide the medical students with some experience in clinical assessment, i.e. history taking and physical exam techniques. We’ve been through three of these classes so far this year, and given that the current block of study is the gastrointestinal system, the focus was on the gastrointestinal tract.

The patient that we saw this time was a 62 year old gentleman who had a previous history of diarrhea with urgency, and was subsequently diagnosed three months ago with rectal cancer. He was in the hospital currently recovering from a resection of the tumor following three months of chemo and radiation therapy. Aside from what looked to be some irritation of his incision, he was in good spirits.

First let me say that it always a pleasure to talk to patients, at least it is at this point in my medical career. This is, no doubt, because they are screened beforehand. So those patients that are cranky, hard to deal with or generally out of sorts I never have to deal with. Or rather, I haven’t had to deal with them yet. I am sheltered and thankful for it. The patient that I talked to today fit that bill – he was friendly and talkative even after spending the last number of months dealing with a horrible debilitating disease.

I was struck by the fact that the patient though lucid and talkative knew relatively little of what had happened to him. He knew generally of disease, he knew that the cancer had been removed and he knew that he had been on chemo / radiation therapy but he didn’t know the details. He didn’t know what the drugs were that he had taken, he didn’t quite know why he had had treatment for cancer before the cancer was removed and he didn’t know exactly what had been done on the surgical side, or how it would affect his ability to go to the bathroom (in the future). It’s interesting to see what the patient, an articulate and intelligent man in this case, was concerned with and what was secondary in his mind.

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