Rhys Davies: The patient will see you now

It’s that time of year again when exams rear their ugly heads. Not for me though—this year’s exams are long over. Instead, the third years are facing their first OSCEs (objective structured clinical exams). Last week, I volunteered for one of the numerous mock OSCEs organised for them by various well-meaning educational student societies. I don’t know about them but it was certainly an educational experience for me.

Osler said, “no one is more interesting as an object of study than a student.” Apart from a poorly-timed kidney stone just before Christmas, I haven’t had much experience on this side of the bedside manner so it was truly an education to see what medical students like me look like from the patient’s perspective.

I was the subject of the medical examiner’s favourite, the cardiovascular examination. All the students that passed their hands over me seemed like bright, young, professional things. They all seemed to know where the heart was and how to wear a stethoscope. So far, so good. It was in the details that they began to define themselves. I was amazed that my heart rate could go from 44 to 72 beats per minute while resting on a couch in the space of ten minutes. Equally curious was how the same affected demeanour could come across as calm and comfortable to some while irritable and agitated to others.

Some of them practiced palpation as if it were a kind of massage. Conversely, when other students took my carotid pulse, I felt like I had a gun pressed against my throat. Others still thought that they could get a reading on my cardiovascular health by palpating my socks. It’s a little known fact that a cotton-nylon blend is indicative of coarctation of the aorta.

What particularly struck me were the little flourishes each student brought to the examination. A few asked to see my teeth, conscious of the link between recent dental work and endocarditis. One mentioned that he was looking for koilonychia as he examined my hands. While he moved on to my pulses, I could help but smile at chest pain caused by iron deficiency anaemia. And there was one flash bugger with a pocket watch.

Whilst entertaining, I’m glad I volunteered for the mock exam. I know I benefitted immensely from these things in preparation for my exams last year so it was only right to pay my dues. Far from the stereotype of the medical student “gunner,” medical school fosters a strong sense of fellowship. It’s important to build on and strengthen this community.

Also, as I prepare to rejoin the clinical environment, I now have a better idea of what the patient sees when I pop my head around the curtain. Medical students shouldn’t be superficial; looking good will only get you so far. An audience of one watches as I listen for murmurs. I should palpate firmly but not too hard and feel for pulses, not socks.

And I must get a pocket watch.

Rhys Davies is a medical student in his fourth year at Imperial College, London.