Reflecting on a Part of the Journey

For those that are not familiar, ICM I is the first course of three titled Introduction to Clinical Medicine, the courses designed to teach the medical student how to interact with patients.  Well, I went through that course and each time I talked to a patient, I wondered, “What is the point of this?”  We had this model for the questions that we were supposed to ask our patients, OLD CARTS.  When was the Onset of the pain, what was its Location, how long a Duration when the patient did feel pain, what was its Character (sharp, stabbing, dull, etc.), what Alleviated or Aggravated it, did the pain Radiate, what was its Timing (when did it come on during the day), and were there any associated Symptoms *whew*.  And each patient I saw, I was supposed to ask these questions.  I couldn’t help realizing that I hadn’t gone through much medical school at this point, and that I couldn’t really do anything with the information that the patient gave me.  That was, if the patient was able to give me what I didn’t know I was looking for.  You see, the model works great for pain, but what if someone came in with difficulty breathing?  There went all of those questions concerning types of pain, and those remaining questions had to be modified significantly to make them fit the current scenario.  As I said, “What was I doing?”

Then I hit ICM II, part two of the series.  At this point I was studying the cardiovascular system in my other classes and the ICM II schedule was set to have us students begin learning the physical exam for that system, as well as some of the relevant questions to ask patients based on symptoms.  As I started doing this, it all clicked all of a sudden.  Yes, the cardiology clicked, but I’m talking about the purpose of ICM I.  I now understood what hadn’t made sense before. I had been talking with patients so that I would be comfortable talking to them and so that I would know how to ask medical questions to get certain answers (strangely, there is an art to this).  I found that while talking with patients, I didn’t have to use model that I learned in ICM I because I knew a little better what I was looking for.  But understanding how to phrase questions to get the answers needed, knowing how to make a patient feel comfortable, or just being able to talk with them, that was all ICM I skills that weren’t learned from a book.  No, these were skills that were only acquired by doing and experiencing.  I now look back at ICM I with great fondness as getting my journey with patients off to a great start.



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