Monday, March 08, 2010

So apparently you can't say 'feel' while performing a breast or pelvic exam in the Standardized Patient suite. Not only can't you say, "I'm NOT going to feel you up, this is going to be a highly professional breast exam," which is probably just as well...you can't say "That FEELS normal," or "I'm going to FEEL for any abnormalities" or "Now I'm FEELING your ovaries."

"Look," it turns out, is also inappropriate. But think about it. That means no "That looks normal" or "I'm looking for abnormalities." It's not like I'm going to say, "Lookin' good," or anything.

So what verbs EXACTLY, I asked, my blepharospasm playing up out of annoyance, are allowed? Well, there's "Examine." Also "palpate," which for my money sounds filthier than either "look" or "feel." Really it seems to me that we're getting a little carried away with the Roget's Thesaurus and using 50-dollar words for the precise words we're not allowed. How would you define 'examine' to a five year old? "Looking at something carefully." What is palpation to a ten-year-old? Feeling very carefully. It's linguistic acrobatics, and in my opinion (as long as one is sensitive to the patient's needs and comfort) unnecessary; however, as I'm being graded on this, I shall palpate and examine until I'm working on patients I know, who are less litigious and with whom I have greater rapport--and then I will commence feeling and looking again. It also goes without saying, but in the SP suite as on Arrested Development--NO TOUCHING. (Not literally--you just don't call it touching).

The problem is, even knowing these rules, you WILL say both 'feel' and 'look.' Multiple times. Because that's what you say, and I'm pretty damn sure I've had health care providers use those words when performing exams on me. Ok, when Dr. W. (whom you all know and love) told me, "Looks good in there," I did sort of wrinkle my brow and fight the impulse to say something like, "Thanks, I had someone in to clean before my appointment." But otherwise her technique is unassailable, if a little blitzkrieg for some people's taste (possibly because few women like to think of their cervix playing the part of Czechoslovakia). It's the opposite of the slow approach we're being taught, but when it comes to the unpleasantness that is a pelvic exam, I personally would rather have a practitioner of the Ninja school--in and out in an instant, leaving no trace behind.