Please avoid the nipple

15 Jan

It’s back to school and that means back to more awkward clinical examinations.

Last week, we had our last practice session with a simulated patient.  From here on out we’ll be going to the General Hospital with only real patients.

Our simulated patient was a 70 year old man, who worked as a gardener.  We decided to practice going over the examination for the central nervous system.  We started with the mini-mental state exam, which is what it sounds like.  One of the questions to test higher functioning is to ask to hear “world” spelled backwards.   Our patient hesitated for a long while but couldn’t do it.   We tried the other test, which is to count down from 100 by 7.  He said “100.. 97…”, he had memorized the answer to the other version of the test, which was to count down by 3.   Some of the people in my group felt uncomfortable and laughed to cover it up, which stirred something in the patient.  To his credit, my group member who was actually doing the test didn’t laugh and just waited patiently for his answer.  The patient had been sitting quietly during the entire exam, but spoke up to say, “Let me tell you something.  My mother abandoned me when I was three weeks old.  I was raised by an adoptive family.  So they didn’t teach me to spell such words.”  The room was quieter after that.

We moved on to testing the sensory system, and the tutor reminded us to test dermatomes T4 and T10, which are at the level of the nipple and umbilicus, respectively.  My group member doing the test opened up the gown and picked up the opened up paperclip that we use to test the pain and crude touch sensations.  He told the patient to let him know if he felt a sharp touch (end of the paperclip) or a dull touch (the bent end of the paperclip) and went ahead and poked the patient with the sharp end right on the patient’s areola.  “Sharp or dull?”   He went on to poke the other nipple with the bent end.  Our tutor told us that we should try to avoid the nipple.   This poor 70 year old man.  My group member went on to test for fine touch, which is done with a cotton wisp.  Again, he went right for the nipple and brushed it with the cotton wisp.  “Do you feel anything?”  My tutor said, “Again, please try to avoid the nipple.”

Sometimes when you’re doing an exam it’s hard to keep things straight.  You’re taught to do things that you’d think would hurt (sticking your fingers way into someone’s neck to feel their thyroid, tugging hard at someone’s knee to test their cruciate ligaments), and common sense easily goes out the window for things you clearly shouldn’t be doing (tickling someone’s nipple with a piece of cotton).


4 Responses to “Please avoid the nipple”

  1. shannon January 15, 2012 at 10:23 am #

    ahhhhhhhh. ugh. i literally cringed when you said that somebody laughed. i can’t even.. what’s wrong with people? 😦

    • Sunny January 15, 2012 at 11:16 am #

      yea… no good. part of the problem when you don’t get enough “whole patient” kind of perspective, i think.

  2. mon January 16, 2012 at 8:59 am #

    LMAO at the “please avoid the nipple”

    But I concur- my heart sinks when people laugh and are ignorant about life experiences. Good for the patient for speaking up!


  1. Talented friend! « Kinda Cliché - January 16, 2012

    […] also very talented at making thoughtful comments on my blog . I really appreciate her perspective and that she can laugh with me at the painfulness […]

Whutchu sayin'

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