CPD- Weeks 1 and 2

CPD= Communication (skills) and Physical Diagnosis

A required class for 2nd year medical students. We are put in small groups of 6 students with one physician (clinical tutor or department professor) and given an actor/patient to interview. This happens 1.5 hours twice a week for 4 weeks.  (So that is 8 "patients" if you are keeping track.)  So far we have only focused on the patient history and interview (physical exam starts after midterms). It has been a worthwhile class and a bit of fun as well. I thought I would tell you about my "patients" as they have provided me with an opportunity to practice being a medical student in the clinical context which is one drawback of going to school here versus in the US. Anyhow, we only end up doing one interview a week because each person must first do the interview (about 15 minutes)  and then have a feedback session which is opened for all students as well as the clinical tutor and actor/patient.

Its a good time and I'm kind of sorry we are done with it so soon... but I have a few "patient" histories to share. (Nope, they are not written up in proper H and P form, sorry! We haven't gotten to that part of the class yet. And I'm too tired or lazy to attempt right now.)

Pt A: Male 28 year old, local Grenadian waiter who lives alone and has an uncomplicated past medical history. Negative family history. C/C: Productive cough for 3 weeks with bloody sputum.  Also has night sweats, anorexia and unintended weight loss.
*This was my first time taking a standardized history but I have clinical experience as an EMT and clinical researcher so talking to a patient was not a novelty to me, as it was for some of my classmates. Needless to say, I found it kind of fun and not difficult at all, though I did forget to do a Review of Systems, like I said this was my first time doing a standardized interview and I didn't really have the list memorized, yet. My clinical tutor was very gracious with her praise. Good times.

Pt B: 54 year old married female with 40 year pack history of smoking. She was an archeologist that was on the Island on sabbatical. Same presentation and symptoms of patient A.
*I only got to finish the interview that one my colleagues started so it was not a very comprehensive experience. (I was moved from one group to another so I think that it was an accident that I got to see the same diagnosis twice.) The positive social history for smoking was a fun twist.... one of my classmates decided to try the paternal physician approach and condemn her smoking. The only problem is the patient was probably twice his age and subsequently yelling at her didn't go over so well.  (Afterwards he said he was trying to scare her into quitting, he wanted her to know her behavior was harmful to her health...um, yeah, I suppose that is why we have to have CPD class....)

Pt C: A 30 year old local Grenadian. I forget his job.... lived with his girlfriend. C/C: Abdominal pain. When questioned further,  patient had acute pain that started 18 hours ago around his umbilicus and has since moved into his right lower quadrant. +N/V with loss of appetite and fever. Visibly uncomfortable. Negative for social/family or past medical history, etc.
* Not too difficult to interview, he was a good actor and looked like he really was in pain thus it wasn't too hard to act concerned or display appropriate empathy. Did I mention, I like this stuff?

Pt D: A 24 year old retail worker with complaints of increasing frequency of diarrhea within the last 10 days, now going up to 8 times a day. Maybe some other vague symptoms which I cannot remember. HIV+ status but this was only offered if you thought to ask about her current medications as she was not the most forthcoming with details and only answer exactly the questions asked of her. Though at one paint she alluded to a wild past and seemed slightly depressed in her affect.
*I would have loved to interview this patient but unfortunately it was my off day so I only got to watch three classmates attempt, with varying degrees of success as far as finding out about her HIV+ status (1/3) and depressed mood (2/3). We did start having the non-interviewing med student(s) sit outside the room so as not to gain any information from interview(s) that were conducted before the student's attempt. Kudos to our clinical tutor for suggesting this format, we embraced it for the following 2 weeks and patients E-G, H is a story in and of herself....

Which, I'll fill you in on- next time. It is time for me to get some sleep so that I can actually study for micro tomorrow. Yay, midterms are half way over!