Pharmacology is going okay so far. The power of drugs, ooh. (Btw, never take Tylenol with alcohol or after drinking. Acetaminophen, the primary active ingredient in Tylenol, causes irreversible liver damage in combination with alcohol. Thus, my professor - who likes a glass of wine everyday - avoids Tylenol completely.)
Medical interviewing is moving along too. Preventing cultural bias, patient education, all that jazz.
My group discussed proper interviewing techniques on how to gather a complete medical history with our preceptor at our field site the other day. Naturally, some of the questions must pertain to somewhat more sensitive topics - i.e. depression, substance abuse, sexual history, etc.
So when we get that point, our preceptor sat back, folding her hands over her pregnant belly, and asked, "So what are some ways we can ask for a person's sexual history?"
Guy in group: "Are you sexually active?"
Preceptor: "Uh huh ... and?"
Guy: "Um, have you ever had oral sex? Anal sex?" (Sounds funny, but these are actually valid questions that should be asked by any good practitioner since it's best that we narrow down to the very specifics. There are many more people out there than there should be who believes that they're not "sexually active" per se when they're having other forms of sex. Ditto for drug abuse.)
Preceptor: "Okay ... and how would you refer to regular sex?"
Guy: "Regular sex ...?"
Preceptor: "You've listed oral and anal, so how would you ask about just sex? Feel free to jump in, the rest of you."
Guy: "Um ..."
Girl: "Well ... are you ... hmm ..."
Preceptor: "How would you ask the patient? How would you say - describe - how would you ask about just traditional sex -"
Group busted up laughing.
The sad part was I hadn't even meant it as a joke. I was just sitting there quietly and the next thing I knew, my mouth went on automatic pilot mode. As soon as I heard traditional ... "MISSIONARY!" Like those old SATs analogies. Brain fart.
The preceptor was totally unfazed though and she nodded. "Uh huh, that's a position. How else can we ask about sex?"
Me trying to redeem myself: "Gah ... oh! Vaginal ... penetration ..." Just give up, brain.
The whole group was still hiding their laughter and the preceptor gave up on us. "Sexual intercourse! Have you ever had sexual intercourse? Right?"
We sound like a bunch of slow dimwits, but it's harder than you think to find the proper wording sometimes for a patient. We all get the general gist of what we're supposed to ask, but when you're put on the spot and you're caught up with balancing patient and doctor agendas ... the wording tends to escape the mind at some moments. It tends to be easier with a real patient though - you go with the flow and there's no preceptor to pick at your wording problems.
Many doctors should work on interview skills though. Doctors who barely ask questions or who keep their eyes focused solely on the computer records usually overlook things or just leave the patient more confused or dissatisfied.
Group-mate after session: "Missionary, huh? Guess we know what you were doing during the weekend."
If you haven't happened upon this clip yet, Kseniya Simonova - the winner of Ukraine's Got Talent 2009 - is a sand animator and this Youtube video of her skills is absolutely stunning. She used a giant light box, dramatic music, imagination and sand painting to interpret Germany's invasion and occupation of Ukraine during WWII. It pretty much brought the audience to tears.