SP #2

I had my second standardized patient today. It went really well, although for some reason I didn't give any thought to what the patient might be presenting with before we went in there. When the patient said "Oh, I got my heart rate checked at the mall and it was high so they told me to come here," I was a little thrown off guard and thought to myself "How the heck do you PQRST that?" PQRST is one way that clinicians get info about symptoms a patient is dealing with. P=provocative/palliative (what makes the symptom better or worse), Q=quality (what does it feel like), R=radiation, S=severity, T=timing. You can't ask "does your heart rate radiate anywhere?" I thought for a second, asked if she was feeling any other symptoms, then just decided to take her vitals (blood pressure, pulse, temp) and go from there. While I was washing my hands I thankfully had some ideas pop into my head, like asking her if she had been walking around the mall fast or if she had had any coffee before she got measured. Cha-ching! That was it, she had drank two large coffees so knowing that I had the answer right away made the rest of the history and physical go really well. Later on in my questioning I found out that she drank 3-4 cups of caffeinated coffee a day, so when at the end she asked me how she could manage her HR without medications I knew what to say.  This whole semester is geared only toward learning how to ask the questions and perform the exam techniques, and technically since we haven't taken clinical medicine we're not required to give a diagnosis or any education. I still want to be developing my critical thinking skills though. Whenever I'm asked a question I don't know the answer to, my default answer is "Well, since I'm a student I don't want to give you any confusing or misleading information, so I'm going to check with the physician and either him or myself will be back in to talk with you." That's all they want us to say though, as I found out yesterday..they don't want us to counsel/diagnose yet.