A Brave Old World

When I was in medical school, from the very beginning of the first year, we were trained using fake-patients (paid actors). We would go into the room pretending that we were the actual "doctor" and we would address their make-belief concerns and problems, offering up advice, tests, and treatments. This would happen about 2 times each month. What made it scarier/funner was that we would have no idea what the patient was going to be like until we pulled the chart off the wall (moments before going into the room). The only thing predictable about it was that each patient would be based on a particular archetype of patient, for example "The Depressed Patient" who doesn't make eye contact and answers every question with a quiet, "...I don't know..." until you hit on the ONE thing that's brought them here (at which point they break down crying). One of my most embarrassing moments in medical school was doing a patient interview with the "Not-So-Secret Crush" patient.

I walked in and there sat this very attractive, late 30's woman who managed to turn every question or comment I made into a sexual innuendo (ie. in-your-endo), if you know me I was never one of the "smoothest" guys with the ladies and the result was that I turned beat red, stuttered through my interview, and did a piss-poor job of fending off her remarks and ending her advances...to add to the embarrassment there were also four other medical students (strangers to me at the time) sitting behind her, observing my performance, who were laughing so hard tears were streaming down their faces (I ended my interview by abruptly standing up, mid sentence, and leaving the room).

There's also the "Elderly Patient Who Has An STD" made for reminding you to ask about their sexual practices, even if they are advanced in years, and there is also the "I'm 12 Years Old and I Do an Illicit Drug" patient, which is the one that I wanted to bring up briefly today.

When we were in school training for these particular patients, taking a drug history was comprised of asking the youth a couple of simple questions like, "Do you drink alcohol?" or "Do you smoke anything?" or the catch all, "Do you take any recreational drugs?"...These apparently are obsolete, as my attending was relating to us today what he has discovered from discussing the subject with his teenage population.

You really have to sit down with a kid and talk about it for more than a couple of seconds, give him/her some comfort room like asking a question about what OTHER kids are doing, which allows them to indirectly tell you about what THEY may be doing. You've really gotta spend some time with them instead of firing off a simple 1 liner question, for example you might not find out from the question, "Do you drink alcohol?" that they do in fact use alcohol, since the girls don't actually "drink" the alcohol in vodka covered tampons (yes they have gotten A LOT more creative since we were in school). They've also figured out they can get a high from asphyxiation by having a friend choke them out with a leather belt, and I really don't wanna meet the kid who thought up doing Anal Beer Bongs(CHUG!CHUG!CHUG!). Yes, these are all real and apparently work to some extent, just so we are clear though, I DO NOT condone their use in the least.

It's true, we got a pretty good laugh out of our attending describing the new drug practices of the youths of today (I seriously had NO idea how out of the loop I was), but the need is actually very serious for good communication skills in doctors and those of us who are parents - otherwise you might not know that what your son calls "smurfing" is doing a drug found in a well known over the counter medication, that causes the hallucination of blue "creatures" or that your daughter is telling the truth and she isn't actually "drinking" out of your liquor cabinet.

One could say it's a brave new world out there...but really in this respect nothing has actually changed, it's just like it was with me and like it was with you - there will always be young and stupid kids doing idiotic, dangerous, and sometimes unusual stuff...sometimes reaalllly unusual.

Newbie Doc

PS Just wanted to say again that I in NO way condone the use of any of these actions mentioned in my post. I am simply using their comic nature to drive home the point that kid's don't quit doing crazy, dumb stuff just because you have grown up and aren't one of them anymore. I think these previously mentioned actions are stupid, harmful, and in some instances (like choking yourself with a belt..duh!) dangerous.