Crash

Last Friday, I was the representative from my clinical cases group that had to go up to our "standardized patient" lab to get a history for our next case.  For those not in the know, the SPs, as we call them, are trained actors whose job it is to act sick and give a history like a real patient would--essentially giving us a chance to practice doing doctor-ly things on people we cannot possibly harm.  They also usually give us feedback on things that were good or bad about us--questions we should have asked, procedures that were done well or left out, etc.  I've had several of these encounters before, interviewing "patients" for everything from back pain to depression to gout and learning to do a physical exam.  This time, I was one of twelve people who got lucky enough to have to interview a patient who was having trouble breathing, and who we could expect to completely decompensate before our very eyes during the interview.  

Obviously, I was rather nervous going in, but the lab leaders prepped us--just take a history, no physical, keep an eye on vitals.  He'll probably pass out and need to be intubated before you're done.  Ok--no biggie.  When the guy stops talking I'll go ahead and ask for the intubation kit (oh, and for those wondering who in the world these SPs are that would let us intubate them needlessly--the procedures are all performed on mannequin dummies).   I walked in, introduced myself, and took the history--pretty darn well, I'd say.  All the pertinent information was there:  What's going on, how long has it been happening, what makes it better/worse, other symptoms, past medical history, family history, even some social history.  Pretty much everything you could ask a patient who's hacking up a lung right in front of you.  And so I finish asking pretty much every question I know to ask--and he's still just coughing away.  There was no one in the room with me, no one to turn and show the vitals, no one to offer me labs or other information.  So I stuck my head out of the room and asked for labs.  "There are none."  Ok...   Sickly dude is telling me how frightened he is and wants to know when his wife will arrive.  "I'm sure she'll be here soon, sir, don't worry, we'll take good care of you and get you feeling better."  Finally, someone random comes in the room.  "Have you done your history?  Did you ask (X) question?  What about (X)?"  Done, done, and done.  I read him the entire history.  "Well have you done a physical?"  They told us not to, but whatever, so I listen to the guy's lungs (which, obviously, sound FINE since this guy is in fact not sick, but whatever).  Turn back to the helpful guy--"So what's going on with your patient?"   Well, he's sick.  He's having trouble breathing, started a few days ago, can't get up today.  His O2 sats are dropping, along with his blood pressure.  "No, I mean, what's going on with him RIGHT NOW?"  He's resting.  "Are you SURE?"  Crap.  

After ascertaining that Mr. Actor Guy was, indeed, no longer responding to my shaking him and asking him if he was ok, I turned to Mr. Helpful Guy (or, not so helpful at this point) and inform him that Mr. Actor seems to have passed out.  At this point, I got to intubate the dummy, which was in all rights pretty neat.  

My only question is, for this whole experience, could we make things a little a) more realistic or b) more timely.  If the guy was supposed to pass out on me before the end of the physical, then he should have.  If he didn't, then there should have been another doctor there because as a med student who has NO background in either pathology or pharmacology, I have no clue what to do for this guy other than watch him cough until he passes out and I can "intubate."   It would have been an awesome experience, were it not for the disorganization.  Ah, well.  Now I get to present him to my group and our resident/attendings who help out, so hopefully they won't bash me too much.