A LESSON I WILL NEVER FORGET

Today one of the four physicians in the clinic where I am rotating pulled me aside to visit one of his patients who had fallen and sustained a shoulder injury. X-rays had been taken and there were no fractures, but he wanted me to perform a physical exam on the patient and make my own inferences. As I walked into the room, he informed me that he would be watching and that I would be expected to answer a few questions after I was finished.

I tried to maintain my composure, but I was holy crappin’ my way through the exam. I visually examined the shoulder and frantically tried to remember anything and everything that I could about the bony structures, attachments and functions of each muscle, nerve supplies, etc.

When that path of thinking reached a dead end, I decided that I would palpate the patient’s shoulder to see if I felt something that might lead me in the right direction. So I felt and felt and felt and then decided that I might need to compare it to the unaffected shoulder. I moved to the opposite side and felt and felt and felt some more.

When the exam was completed, I thanked the patient and the exited the room, shaking in my heels and preparing to make a total jackbutt out of myself.

And then he asked me something that I will never forget.

“Which wrist was the patient’s watch on?”

I had no idea. I was so focused on the patient’s shoulder that I paid zilcho attention to anything else.

“I do not know, sir.”

And then the second question. “What did the patient have in his front pocket?”

Extended pause.
Gulp.
A little more pause.

“I don’t know.”

And the questions kept on coming.

“What color of shoes was the patient wearing?”
“What about the patient’s socks? What color were they?”
“What color was the patient’s watch?”
“Which hand was the dominate hand?”
“What was written in the notebook that was sitting on the table adjacent to the patient?”
“Did the patient have hearing aids?”

The physician then explained that sometimes in medicine it is easy to focus on the disease process and not see the patient in the process.

This is the kind of stuff that you don't exactly get from textbooks, and I will never ever EVER forget this valuable lesson.

EVER.