This morning a third-year student joined the team. Bob wants to do orthopedics, so of course he’s very anxious to shine, and only has till Tuesday to make a good impression, because their rotation ends a few days early for Thanksgiving. With the PA’s behavior in mind, I did my best to treat him as an equal, to explain as much as he needed, and generally try to make him look good, the way residents have often done for me.

The first new patient, Dr. Ashley specifically told me to do the history. So I did, and talked about the physical exam with Bob, and then presented to Dr. Ashley. I got the physical exam findings all wrong. (I mean honestly: is there some form of physical exam “positive attending sign,” where it hurts when the med student does it, but not when the doctor does it, or it’s painless when I do it, and hurts when the attending does it? More likely I’m doing it wrong. . .)

The second patient I thought I would encourage Bob with, so I let him get the history, just covering a few ortho-specific points after he was done, and letting him do most of the physical exam. We looked at the MRI results together, and I had him present the patient to me while we waited for Dr. Ashley to get out of another room. He only missed maybe two things in the story, and his physical exam description was good, except he said the gentleman had full range motion, whereas there was one specific motion which was limited, and the others were great. I explained that to him, and then he told the story to Dr. Ashley. Dr. Ashley took one look at the MRI and said, “There is no way this guy has full range of motion.” It didn’t help that Bob had made the same mistake in describing the motion to Dr. Ashley that he had to me. When we got back in the room, of course he did have almost full range of motion, to Dr. Ashley’s astonishment. I don’t know whether that episode helped Bob or hurt him in Dr. Ashley’s eyes. He didn’t want to do the next new patient history, so I did it, and blundered over the shoulder-specific tests, again.

This helping-students thing isn’t as simple as I thought. Maybe it will work better next year, when I’m two years senior to the third-years, not just one.

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