It seems like it was just yesterday when I first began my journey as a PA student, dissecting cadavers with unimaginable tools for the first time, struggling to absorb a wealth of new information every week, and performing my first complete history and physical exam. In fact, it was only last semester when my white coat was officially bestowed upon me. Today, I am still drinking from a firehose as the learning continues, except now, I also have the incredible opportunity to apply the clinical knowledge and skills that I have gained on real patients.
Every Monday afternoon, there is allotted time in our busy academic schedule to visit patients at a local Duke-affiliated hospital. As soon as the last lecture ends, my classmates and I gather all of our medical equipment, eagerly donning our white coats and stethoscopes, and then dividing into our assigned Patient Assessment and Counselling II (PACII) small groups. Throughout the course, each group gradually works toward performing a complete history and physical exam. Then, after seeing our assigned patients, each group meets with their instructor in order to deliver an oral presentation, receive feedback, and ask questions.
Initially, the experience is tremendously nerve-racking. It is the first time that we assess real patients with real illnesses, instead of assessing each other and discovering only normal findings. Moreover, we all want to avoid appearing incompetent. Personally, despite my professional attire and outwardly calm and collected demeanor, I was extremely nervous and lacking in confidence with my first few patients. My task is to ask a long list of questions in order to elicit pertinent information, and in my mind, several things can go wrong.
However, with each week, I become more and more comfortable with my role, and my concerns begin to dissipate as my interviewing skills improve. For instance, not only have I learned the proper way to phrase sensitive questions, but I have also learned the importance of silence. With practice, my conversations begin to flow smoothly and logically. Not only do the patients have confidence in my abilities but I start to develop confidence in myself as well. Nonetheless, obtaining the history is only one portion of the patient encounter. I also must complete a thorough physical exam.
The complete physical exam is a full head-to-toe exam in which every body system is evaluated. During this exam, it is my priority to be empathetic and to avoid making the patient feel uncomfortable. I have learned to customize the exam based on each patient’s condition, and I have also learned techniques that allow me to respect patients’ privacy. Truly, each patient encounter requires patience, understanding, creativity, and most importantly, it improves with experience.
Overall, I am very thankful for this hands-on experience. Simply being able to interact with patients has been the most rewarding part of PACII. It has allowed me to realize how much information I have retained in such a short period of time. It amazes me when I am able to determine appropriate follow-up questions based on a patient’s presentation and responses, when I am able to successfully evaluate abnormal findings, and when I am able to connect signs and symptoms with valid diagnoses. I am particularly proud whenever my predicted diagnosis matches that of the patient’s actual diagnosis. Indeed, this is evidence that the Duke PA program is preparing me well for the real world, and this wonderful opportunity to help the community is a reminder of why I am in PA school.