Wednesday, June 1, 2011

*Warning: this post will be mostly my sok sek sok sek, and it's quite long*

Did you see that horrified look on me?
U didn’t?
Come, I’ll show it again.

That was the expression I was wearing on my face as I walked out of my last physical examination station; the hypothyroid case.

Before I start babbling about how poor was my performance in that station, and how not-so-professional I was in other stations, let me just briefly explain how this clinical exam is carried out.

It is called Objective Structured Clinical Examination; OSCE

I talked about my first experience with OSCE last year, during my end of semester 3 exam.

Basically, we will be given 40 secs to read the instructions outside the room and when the buzzer rings, we have to go in and examine the patient, according to the case given, the one we read outside the room.

And in the room, there will be one simulated patient (a patient who’s not sick but is pretending to be and is either ready to cost us our marks at any time we went wrong or accidentally scratched his skin, or a helpful one who will give us subtle tips throughout the exam) and a doctor, who will be holding a score sheet and ready to mark us. We are given 5 minutes to perform the examination on the patient.

There were 4 physical examination (PE) stations, 2 history takings and 2 self-standing stations. My first PE was considerably okay. It was a pleural effusion case, and I am quite confident in a respiratory case, having examined before during semester 3. And the examiner was a Dr from IMU Clinical School. He did not let me complete the whole procedure; he stopped me when he saw I was doing it fine and asked me to proceed to the next step. We have to percuss the patient’s back for 3 levels but he stopped me when I’ve done two. I assumed it’s because he doesn’t want me to waste my 5 minutes doing something that I know how to do.

I finished earlier than the allocated 5 mins and the doctor did not look annoyed so I was quite happy as I walk out the room *grin*

My next station was a Nervous System station; patient had right-sided hemiplegia, upper motor neurone lesion and we're instructed to inspect the motor function of the facial nerve. Having practised quite a few times with Hui Fong and Ah Kiew, I can do it quite well (I think) but I am pretty sure I lost the 1 mark for confidence. I didn't appear confidence, at all. I was slurry and too fast when I answered the questions given, that Dr Sow had to ask me to repeat.

Anyway, the first 2 stations were okay.
Then comes the 3rd station.
Dr NKM's hip examination.

All this while we were taught to measure patient's legs to determine if he has congenital deformity or any other diseases that deforms his legs. And all this while, the patient's legs are straightened.

Suddenly today, the patient's right leg were injured, that he can't straighten it.
I did not know how to measure a bent leg!
I was almost "pleading" the patient to straighten his poor leg so that I can measure it.
But to no avail.

And usually, while palpating for any bony structures, I have to say that I can't really feel most of what I said I feel. Greater trochanter of the femur for example, I do not know which one exactly is the greater trochanter so all this while I've been "pretending" to feel it.

And my examiner today; Dr NKM is an anatomist.
All other doctors will be sitting at the corner of the room, to mark us.
But he doesn't. He'll really look at what we're touching,
And he's an anatomist, a superb one so there is absolutely NO WAY we can "pretend" to touch the structures because he knows exactly where it is.
But he was quite friendly so I still walked out of the room smiling.

The Killer, Killing and Killed Station

There was an ECG, and we're supposed to interpret it and examine the patient ACCORDING to the findings on the ECG.

And I have no idea what the ECG was showing.
And matters got worse when the doctor was Dr JK; a known doctor for her strictness.
I hentam-ed and said it was an ST-elevation and it could be a heart attack. She simply nodded and asked me to proceed.

As I asked for the patient's permission to inspect his chest, he was surprised and said, "Chest?"
That alarmed me. Could it be NOT chest?
And when I asked him to remove his shirt, he said he's cold and refused to remove it.
THEN ONLY I realised the existence of a water bottle next to him.
So then only I know it was a THYROID case.

So after performing the neck inspection and examination, I kept quiet and stood still for I did not know what to do next. *There goes my confidence mark*

So Dr JK said, "If you do not know what to do, I can tell you what you should do next"
Me: "Oh yes, pls"
Dr JK: "Do the biceps jerk"

So I did. Then I reported the findings that we might get in a hyper or hypothyroid case, since they will be different. Then suddenly she raised her voice, "And what case is this actually?!"
I was dumbstrucked.
Then only I re-read the instruction on the table, and noticed the first sentence,
"This patient is suspected to have hypothyroidism"

I so want to scream at the tops of my lungs at that moment.
"I'm sorry! I did not notice that sentence before! I missed it!"

Dr JK: "Then that's too bad"

-Because life is a test- -AkMaR-

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