Be advised: this thread is not for serious in-depth discussion of weighty topics (we have a link for that), this thread is not for anything Culture War related. This thread is for Fun. You got jokes? Share 'em. You got silly questions? Ask 'em.
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While more relevant to @Throwaway05, @Pigeon and any other doctors lurking here, I have a funny story from work. For context, if you don't know me, I'm a doctor from India, who, having passed one heap of British medical exams, while still recuperating (and losing sleep from the residency matching process) for another, happens to be working at one of the more prestigious hospitals back at home. In India, almost all of our own exams, including from med school, involve actual bona fide sick people, even the more fancy ones.
I turned up, as usual, only to find my ward crammed with dozens of obviously senior doctors and not a patient in sight. And I didn't sign up for any medical conferences, I only attend them if there's a buffet table and booze.
Turns out the MRCP PACES exam, which, as the acronym would suggest, provides membership to the Royal College of Physicians in the UK (basically internists, but sounds cooler), was being conducted there. It involves somewhat more involved cases and more tricky diagnoses than what I had to endure in my own British OSCEs. And which I hope to never have to give myself, since I just want to be a fucking shrink, I don't care to palpate your liver, no, not even if I'm seeing you after a paracetamol overdose. Palpating the fake prosthetic tiddies on a grinning male actor while doing my best to look in the eyes (up there, a bit to the left) the actress who supposedly had a breast lump somewhere in there takes most of the fun out of it.
And nobody had told me. Cue me gingerly creeping to the doctor's room, which kept getting invaded my yet more cute postgrad trainees/residents. I'm not one to complain about that, but I really wanted some fucking sleep.
Eventually, I spotted a girl feverishly reading MRCP station notes, and I enquired politely about them only to be told she wasn't giving the exam herself.
Huh?
Like, I'm not the most passionate doctor around, but it's pretty rare to study for an exam you're not fucking giving.
Turns out that in lieu of highly trained professional actors fluent in English, as is the case in the UK, at least as far as I can recall my friends telling me, or by googling it myself, they just recruit the medicine residents in India.
Well, it must be fun to be on the other end of the poking and prodding. I recall them chatting about how one poor bastard had to endure some particularly painful tests, and had to do his absolute best from wincing as his abdomen was molested in an effort to find something wrong with his perfectly normal kidneys. Why? Because the test wasn't supposed to be painful, and if he did show his pain, that would be interpreted as an intentional clinical sign by the examinees, who not having access to the script, would then promptly jump to the wrong diagnosis and thus immediately fail the station.
Funnier still were the ophthalmological exams, since a few of the over-qualified patients had visual issues of their own, and the imaginary platonic ideal of a patient they were supposed to embody didn't. One of them found out he had a heart murmur the hard way, which has to suck, but I heard that the examiners did end up agreeing to pass the people who noticed that particular divergence from fiction.
Well, I guess it beats seriously ill patients being subjected to the same, it's a bit awkward when they die on you or have to shifted to the ICU mid exam, really wreaks havoc on the grading. Well, I've no intention of giving the MRCP, but it was sure funny to just sit there and munch popcorn as the bacon was made, until someone guilt-tripped me into admitting my lack of productive work to my boss and I was reassigned to another ward for the week. Eh, it was good while it lasted. If I do ever give it for the lols, I'll hope the 'patient' takes pity on me or wants respite from my fumbling, and just whispers the diagnosis to me instead. They'd probably know better.
There are multiple inaccurate things the GP mentioned about the PACES exam.
For example, if any of the patients or actors wince or show distress during any part of the PACES exam, the candidate will likely fail the whole exam. This holds true regardless of whether the candidate got the right diagnosis or otherwise performed well in that particular station or in the exam as a whole.
Huh. I'm just as confused as @netstack. Surely there must be some cases where an expression of discomfort is expected, as it would be IRL?
If there's a gentle way to palpate a kidney, I haven't heard of it. As far I know, it's usually not possible to even feel them in normal patients, unless you go hard. But I never said I was a good internist or interested in it, so I could well be wrong.
Why do you think palpating kidneys is painful? Have you tried it on yourself?
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Really? That seems like a pretty high bar to clear. What if the station is supposed to be, I dunno, appendicitis?
Do you think an actual appendicitis patient will agree to be be palpated by 20 different doctors in one day?
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Is that a bad outcome? If the examinees are conducting the test incorrectly such that it caused pain, and then jumping to incorrect conclusions as a result, that is something that will lead to incorrect conclusions when done in the real world on real patients, and deserves to be flunked.
Unless what you mean is that the test "officially" doesn't cause pain despite frequently causing pain in practice even when done correctly, such that the students are not to blame for the inevitable mis-diagnosis because the expected exam answers are flawed.
Kidney palpation is difficult, you have to really dig into it, and there can be spurious confounders, like someone being bruised (maybe they were after a dozen people had done it), too fat, and so on. I've never had much luck with it myself, and you have to go hard to even expect to feel it.
There are certainly clinical exams which are useful and done in reality, but I sincerely hope nobody is making serious decisions off of one, in the absence of other tests. I presume that's what the medical resident knows better than I did, and hence why they took pity on the people desperate to find any hint towards a diagnosis, after all, he was healthy, as an actor he was expected to make shit up and feign pain and discomfort where it's expected, even if he didn't actually feel it.
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Wait, what does a heart murmur have to do with his eyes?
Nothing at all, I'd hope.
This is a different resident, he's asymptomatic, but does in fact have early heart disease, since from the overheard description it wasn't an innocent murmur. But I had work elsewhere and no shortage of other patients with cardiac issues, so my curiosity was sated.
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