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Helped by a patient's laugh

By Susannah George

'Would you like to examine this lady’s cardiovascular system?' I took a deep breath, introduced myself, and launched into my routine. It was quite slick by then: I had spent the past few months practising it on everyone from my parents to my teddy bear, and subjecting every patient I admitted to a comprehensive MRCP-style clinical examination.

Except this time, the patient was a woman with congenital heart disease, rarely seen in clinical practice, but extremely common in exams. And I couldn’t put the signs together. I got to the end of my routine without knowing what was wrong with her.

There were two ways of presenting my findings: the clever way, where you give the diagnosis and back it up with supporting information; and the other way, where you list your clinical findings and then conclude with the diagnosis. I opted for the latter.

And then something happened that had never happened before. The patient laughed at me. In the few years since I’d qualified, I’d elicited a broad spectrum of reactions, but never this. I tried to keep going, aware that I was probably falling down even more. I tried to see what the consultant was thinking. The corners of his mouth were turning upwards into a smile.

Eventually, he put me out of my misery and got us all to have another go at identifying the signs. We thanked the patient, who had waited behind at the end of her clinic appointment for the teaching session, and said goodbye.

‘Good luck for the exam,’ she said, having now stopped laughing.

In the following weeks, we had numerous other teaching sessions, or practised on the wards in groups, seeing patients with new heart valves or interesting neurological signs.

Occasionally, I found myself thinking about all the patients I’d met through my exam preparation. They wouldn’t derive any benefit from helping us. I wondered if they ever thought about us again. Did they wonder whether we’d passed or failed? Only once did I see any of them again.

Soon after the exam, I was in the medical assessment unit, and caught sight of a familiar face on a trolley on the other side of the room. The woman from the cardiology clinic had been admitted. Because she’d given up her time to help us, I knew what was wrong with her. It was a rare occasion when a patient who helped out with our teaching might actually benefit from doing so. I finally got the chance to thank her and tell her I’d passed.

‘Well done, congratulations,’ she said through her oxygen mask as she gripped my arm. She was genuinely pleased for me, and this time she didn’t laugh.

Susannah George is a specialty trainee 4 in dermatology in Brighton. At the time of the incident she was a medical SHO