Getting a clue

An SP giving a clue card to a student after a heart & lung exam.
[Detail from Card Players via wikimedia]

Obviously, most SPs do not match the physical findings of the cases they portray. There aren't enough of us to specially cast in cases which include findings like heart murmurs, abdominal masses, retinopathy, swollen lymph nodes, clubbing, etc. And despite the fascinating and helpful tips in "Training Standardized Patients To Have Physical Findings," it is almost impossible to simulate these findings, either.

So I usually give student doctors a card that explains the finding after they've finished an exam which might reveal it. Each school has a different method for doing this. Students are usually visibly triumphant when they receive a card, as if they have won a prize.

However, student doctors almost never share that finding with me as a patient. Once they get a card that describes the abnormal results of a tactile fremitus exam, for instance, they continue with the rest of the exam as if nothing had happened!

I find this tremendously frustrating as an SP because they lose out on the chance to practice giving findings that are not within normal limits without alarming patients. I want them to practice offering contextualization, risk or reassurance in these situations, to help me understand why the finding relates to my chief complaint. Without that practice, they will be behind the curve when it happens to them later.