The Helpful Patient and the medical student.

   Apart from all the philosophical rhetoric, a good patient doctor relationship can have quite an unimaginable payoff.  I am going to  tell you a story to illustrate exactly what I  mean.
   One day, many many years ago, when  I was facing my final examinations to  become a physician,  I had to demonstrate my clinical prowess by actually taking a history and examining a patient and reporting on any physical examination abnormalities I discovered.  In those days, we actually talked to and examined a patient volunteer, not a simulated patient, not a model, not an interpretation of some photo or videotape.  In other words a real live  patient. Time was limited, so one had to establish some sort of rapport with the patient quite quickly, get an adequate history and proceed  with the physical examination, then write up one's findings.  You were not required to make a diagnosis in this particular test, its purpose was to evaluate history and physical examination skills.
   My patient was Mr. Murphy, a working class Irishman with some chronic disorders, who had been volunteering himself as a test patient for a few years, convinced that he was helping medical science, which indeed he was.  I introduced myself to him and we shook hands.
    " I'm a medical student so  thanks for seeing me.  I have to  take a history and then examine you, if that's alright".
   " Oh yes, doctor, that's fine, I've been doing that for a couple of years now".
   I started asking the appropriate questions, which he answered in a pleasant, rather roundabout way as the Irish are wont to do.  Between my questions, Mr Murphy would interject with some  questions about me which really had nothing to do with the case.  I answered him, and over the next  little while we developed a nice rapport, which nowadays folks like to call the "doctor - patient relationship".
   Then I commenced the physical examination.  His ears, nose and throat were normal.  His chest was a bit wheezy, but no  more than one would expect of a lifelong smoker.  Then I came to the abdominal examination. 
   "That's the part they have a little difficulty with, doctor," he smiled at me.
    He was a little on the fat side, but not really obese.  I poked around and poked around trying to get the landmarks I needed and started to get worried that I wouldn't distinguish anything.
    "They always say they have a little difficulty finding the lower margin of the liver,"  he said  encouragingly.
    "So am I, Mr. Murphy," I said apprehensively
    "Well, it's just a couple of inches below where your fingers are now," he said and added, "you'll have to dig in there quite a bit deeper than that, you're being too gentle".
    I moved my fingers down an inch or so and then dug deep into  his abdomen.  
   "I feel it now," I answered relieved.  "Am  I hurting you?"
   "Don't worry about that" he said, "you should measure how far it is below the rib with  your tape measure, that's how they like you to describe it."
    "Thank you so much," I said.
    "Think nothing of it," he  replied, then added with a grin, "they think  my spleen might be a bit enlarged too, but they're not so sure about that."
     We shook hands.  "Good luck  in  the exams, doctor," were his final words.
   How is that for an example of the benefits of a good doctor-patient relationship?