So we don't have a two-tier system already...?

[BlackJack]

How come, on certain clinical rotations, if there are two student-friendly patients to be seen in clinic, I am sometimes consistently assigned to see the indigent, unemployed, or otherwise socially lower-tier patient, while the attending always takes the upper-crust types?

[Satsuma]

Hmm...interesting. That hasn`t really happened to me.

BUT at the same time, it's a great population to get skilled at dealing with. Also, as a student you would be able to spend more time around the social issues and things that the attending wouldn`t have time to do. So maybe your particular attending just thinks you have time to do a more thorough job with the history taking etc?

[chemgirl]

If there was a choice, I would be asking to see patient number 2 on purpose for great practice in history taking and dealing with a potentially difficult patient. I have the time to spend with this person discussing their social as well as medical issues, whereas the attending may not.

 

I agree with Satsuma. While I take 45 minutes to take a great history from this patient, the attending can see 3 or 4 of your patient number 1 types, and then have me present the most salient points of the complex history of the other patient.

 

I have often thought that when I am around in the ER or clinics, patients like this actually benefit from having a student that will take this time and the attendings I have worked with seem to agree... many of them have said that I took a great history and that they would have never had the time to delve into all the points we discussed.

 

One caveat... I think this idea works for students in third or fourth year who have at least had practice in history taking. I can't imagine said patient would benefit in the same way having a first or second year student take their history.