Wednesday, February 29, 2012

When Med Students Pretend to Know

Hugh: So, Doc tells me to go ahead and do the vag exam. I'm hoping he'll, you know, teach me how to do it. So I get gloves on...wait for Doc to come and help me out. I pretend to spend ages looking for lube hoping Doc will join me, the nurse gets annoyed and asks if I am going to do exam or not. I put on confidence face hoping that it hides fear face and tell her uh yeah! as I realize doc is actually now scrubbing up and has no intention of teaching me.

So I put a finger in and think Shit! what am i supposed to be feeling for? I kind of move my finger around and try to figure out the noteworthy anatomy and all I can think of is the vagina is so spacious! I can't feel a damn thing! Then I think if only I could put TWO fingers in, then maybe I could feel something...but I don't want to look greedy so I just keep to the one. How are you supposed to feel anything in there? How are you supposed to actually do a vag exam??

Me: [Initially unable to speak due to fit of laughter and piece of chicken lodged in my throat] Dude, first of all, never put the words 'spacious' and 'vagina' together in a sentence ever again. Second, two fingers isn't 'greedy' it is proper technique. Third, there is a reason it is called a bimanual exam.

That was an excerpt from recent dinner conversation with MD student currently on obs/gyn rotation. In fairness, Hugh is actually a very smart, personable, and responsible medical student. And yes, he had consented the patient to perform a vaginal exam under anesthetic prior to her procedure. It is probably good that she was asleep.

I am sure the nurses thought he was a complete idiot while they watched him flounder. But this whole story illustrates one of the pet peeves I have about medical culture. Medical students are students which means they are allowed to not know the right dose of clopidogrel the first time they see a heart attack. They are allowed to not know how to do a bimanual exam the first time they are faced with a real person and not a doll during a 1st year clinical skills lab. But yet the culture of medicine makes you think that you should know everything at all times and if you admit to not knowing, you are admitting to being a sub-standard medical student / future doctor / human. So as I nurse I witnessed loads of medical students pretending to know how to do something and not asking for help or not admitting they hadn't a clue.

It is scary that even as students we are afraid to admit we don't know, admit when we need help, or admit we're in over our heads.  What happens when we grow up to become real doctors?


I know there is a fine line between looking incompetent and looking like someone who might have a clue, and clearly everyone would rather be in the latter category. But I can honestly say that in the past when I've admitted that I didn't know something in similar situations the person is usually happy to explain or demonstrate (passive-aggressive bullies, aside). In fact, afterwards (again, passive-aggressive bullies aside) the teacher generally trusts you more because they've seen that you're willing to admit your shortcomings, i.e. that you are safe.

I fear that many more botched vaginal exams will occur before medicine accepts learning and ignorance as part of medical education. In the meantime, confidence face?


OMDG said...

This was so funny ABB. So funny, and so horribly true.

I've also run into the problem where if you admit to never having seen/done something before, nobody will take the time to teach you. Eventually you learn that in order to learn, you have to just go with things sometime. Which is scary and probably not the best for the patients.

the golddigger said...

I'm not sure if I could tell the difference between a knowledgeable pelvic and an amateur one. :)

Absentbabinski said...


Well done that man. I'm a firm believer that being a doctor involves a bit of *being* what people expect. And, perhaps more relevantly, always pushing yourself - doesn't sound like yer man was dangerous or incompetent, just swimming out a little further than he was expecting.

Good practice for the real thing, I expect.

Shrtstormtrooper said...

While I feel bad for the resident, and could wax poetic about the injustice of medical professionals consistently being in situations where they learn without being taught...I can't get past the vag exam picture. It's so gloriously hilarious. Well played.

Anna Elissa said...

I find that when we're in medical school, we'll eventually learn to wear and confidently display that confidence face (or poker face at the very least).