Michael Wang: The Compassionate Clinical Exam
Selected Excerpts
“”What brings you in today?” I asked, dutifully following the script. After a few more questions and answers, we had arrived at the cue for a physical exam. I placed 2 fingers on the SP’s wrist, palpating his radial pulse. Count for 15 seconds … 25, 26, 27, 28? His pulse couldn’t possibly be 112, I thought—SPs are good, but being able to simulate abnormal vital signs at will would be a superhuman feat. A moment later, I became suddenly conscious, once more, of my own heartbeat in my ears. My eyes widened as I realized, “My god, he’s nervous too.””
…
In reference to OSCEs, our clerkship handbook says, “We know it’s fake, but try to make it ‘normal.’” But I’ve come to think that what is most fascinating about the theatrical exchange between medical students and SPs is not the way everyone suspends the feeling of absurdity but rather how genuine doctoring can take place if we allow it to. I have long forgotten the content of that case, but I won’t soon forget the day an SP and I shared a moment of tachycardia.”
Discussion Questions
What does this essay say about the physical exam as performance?
With modern medical technology, some argue that the physical exam is losing its relevance, but what information can we gather from this physical interaction that other diagnostic modalities may miss?
Sensory deprivation from touch is yet another consequence of COVID-19. What are ways we can cope with this absence and maintain social connection?
Reflections from #MedHumChat
“I loved the mutual vulnerability - the awareness that both are watching each other. Then again, this simulation has a very different power dynamic. I wish there were more mutual vulnerability and less power imbalance (especially epistemic power) in [healthcare] encounters.”—@OdyO11
“What moved me the most from this essay was the insight regarding the value/importance of touch - "I came to understand the human behind the character." Touch reminds us that we are all human, it's grounding.”—@LReedsbooks
“Physical exam is the foundation. Each advanced test comes with risks, adverse exposures, and potential incidental findings (too sensitive in ways) that can create a chain of more unnecessary tests. Our physical exam leads to purposeful testing.”—@sharanauth
“Touch is only 1 of our many tools. recognizing its absence can get us to think of creative ways to compensate: focus on the quality of the interaction, can we make up with better listening? Less interrupting? More compassionate statements? more open body posture?”—@shabsjams
About this #MedHumChat
“The Compassionate Clinical Exam” by Michael Wang was paired with The Nocturnists: Black Voices in Healthcare (Episode 8: Touch) for a #MedHumChat on December 2, 2020 on The Power of Touch.
The piece for this chat as well as the discussion questions were curated by Jennifer Caputo (@jennifermcaputo).
About the Author
Michael Wang is a third-year medical student at Northwestern University Feinberg School of Medicine.