Clinic Experience

Yesterday, I shadowed a couple interns at the campus health center.  My first patient observation was an interesting one.  Her condition was pretty obvious right off the bat and it became more complex the further the visit moved forward.  She had an interesting autoimmune condition which caused significant pain every time anything touched her.  Although, I couldn't help but notice that when she touched things, she didn't yelp in pain.  It was only when the intern palpated structures when the pain became present and extreme.  Is this a trust issue, where anyone who touches her inflicts pain because she has been physically or emotionally hurt in the past?

The interns moved forward to help relieve her pain by stretching her iliotibial bands, her piriformis muscles and glutes.  She gasped for air every time the intern palpated a landmark as if she was being assaulted.  It was a little tough to watch because the lady was clearly hurting at an intense level, at least it seemed like that.  I could tell the intern had to use a high level of patience and reassurance to get the desired results.

I started wondering whether or not she was in actual pain because it was almost over-acted in a way.  She presented with jump signs on multiple areas along her hips and legs but I left not feeling convinced that she was truly hurting.  I want to believe she was in pain but there was something that made me think she might be suffering from psychogenic trust issues.

Regardless of whether she was truly hurting or not, the experience made me realize I will be in those intern's shoes in the matter of months.  I will have to muster up the skills to manage a patient of this complexity.  To look at where I am now and where I need to be, it is a huge leap.  We are sort of in the middle of a proverbial lake and the distance to go back to the shore where we started is getting larger and larger.  The only way to proceed is to get to the other side.

Here we go...