I had a standardized patient interview today and was not very happy with its result. The constructive feed back I recieved was to carry a clipboard instead of a little notebook. I was a little unprepared for the whole situation. I arrived thinking we were taking a patient history, and then was given the patient history before the encounter. What kind of history can I take when everything is already in the chart? So after covering the Chief Complaint and History of Present Illness I wasted a lot of time by talking slowly, taking big pauses. Honestly, I had to spend some time thinking about my next question. But my interviewer didn't like the pausing or slowness. She said, "It made me feel like you don't know what you're doing." Of course, I don't know what I'm doing, so that doesn't help much.

This standardized patient encounter was complicated by the fact that the patient desired a perscription for antibiotics to treat the apparent viral respiratory infection.

Finally, she said that I should have come right out and said that taking antibiotics when you have a viral infection is "bad for you." Instead of saying that it's not the right medicine, or the tylenol and sudafed are the right medicine. I have some ethical qualms about saying that anti-biotics are bad for you in this case. Certainly, they won't help, and, certainly, they raise the spectre of antibiotic-resistant bacteria, but I felt that telling the patient that anti-biotics would hurt her would be a misrepresentation of the risks posed by an inappropriate theraputic response.

Anyway, my biggest regret about the whole event was not standing up to my evaluator and saying 1) I needed to waste time, 2) notebook vs. clipboard is totally irrelevant, and 3) there are ethical issues at stake in the misrepresentation of the danger posed by an inappropriate therapy.

Two jobs ago, I had an almost equally hilarious assessment when my former supervisor told me, "I'm marking your 'teamwork' score as 'needs improvement' because I'm doing that for everyone this year."

Thanks.