"Choose Your Own Adventure" in medical school

The Inkfish blog has a guest post by Amy Savage, a woman who is a professional fake patient — somebody hired to act out an office visit and help medical students learn how to both diagnose patients and treat them well. (You may remember this from the episode of Seinfeld when Kramer and Mickey pretended to have gonorrhea and cirrhosis.)

What you don't pick up from that pop culture portrayal, but that is clear in Savage's essay, is that learning how to ask questions is a huge part of this training exercise. Savage is supposed to provide the medical students with information — but that information might be incomplete or seriously skewed if the students don't ask the right questions, or ask the right questions in the wrong way.

I am expected to give specific, memorized lines about my symptoms, but only if the students ask the right questions in the right way. For example, if a student asks if I use tobacco, that is different from asking if I use or have ever used tobacco products. Asking a woman if she has ever been pregnant is different from asking if she has any children. And, of course, those types of oversights in questioning can lead to different diagnoses.

From this experience, I have learned what to expect from an ideal physician, what to ask, and what not to tolerate. For example, your doctor should not ask leading (or possibly judgmental) questions such as, “You don’t smoke, right?” Nor should they run off a list of questions such as, “Do you smoke, drink, or use drugs?” without giving you time to think. They should ask open-ended questions: “Have you noticed any other changes lately?”

I've also learned that it's important to pay attention to symptoms that may seem unrelated to your chief complaint. If you were experiencing extreme fatigue, for example, you might not think that your newly brittle hair had anything to do with your energy levels, but it could be a thyroid problem.