Breast Exam

One of the more glorious parts of a medical education is the use of standardized patients. To make certain that you are fit to interact with real human beings, med schools start you off with actors that you get to "interview" (i.e. they act like they have a medical problem, you act like a doctor who is unaware of the fact that they are perfectly healthy actors, responding to their concerns with the full range of appropriate emotion and empathy that non-theater majors may find difficult to conjure) in front of a group of your peers, a preceptor who may or may not be grading you (or behind a two-way mirror) and, heck, sometimes a videocamera as well. And all of this starts before you have had any pathology or, in the case of Doctoring class last semester, human anatomy. This is the best way to get you "accustomed" to being in the role of a physician. I did the first interview in our Doctoring class, a few weeks into the semester last year. My standardized patient had pancreatic cancer, and it was my job to convince her to agree to conventional treatment. I thought, "Ah, yes, this is an excellent place to start. If they had waited a few months till I had seen a human pancreas, this exercise would have been quite dull."

This semester, Doctoring begins to encorporate aspects of the physical exam. In keeping with the trend of last semester, the first time we get to touch a standardized patient is to perform... a breast exam. Again, well done Doctoring curriculum committee! To begin by examining the ear, nose, and throat might have encouraged students to feel comfortable, even confident, in their interactions with fake patients. Far, far better to leave all those trivial aspects of the physical exam that don't involve nudity untouched until the student is called to perform them on a complete stranger for the first time during our graded exam. Clearly, this class is organized under the assumption that students who are allowed to feel confident in their abilities will only grow lazy.

As for the actual breast exam? Having spent three hours in a tiny exam room watching seven other people thoroughly explain, then perform a breast exam on the same SP I can safely say that I can both perform and teach a breast exam myself (bringing the number of things I know how to do to patients up to about four), and breasts will never be the slightest bit interesting again.