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The Patient Bank: Volunteers Help Young Medical Students Get Training

  • First-year medical student Colin Tasi checks Nancy Tuttle’s tremors, while Nan Cochran, director of the “On Doctoring” course at Dartmouth’s Geisel School of Medicine, looks on. (Valley News - Jennifer Hauck)

    First-year medical student Colin Tasi checks Nancy Tuttle’s tremors, while Nan Cochran, director of the “On Doctoring” course at Dartmouth’s Geisel School of Medicine, looks on. (Valley News - Jennifer Hauck) Purchase photo reprints »

  • Nurse Practitioner Maureen Boardman watches while medical student Luca Valle checks Brown’s eyes. (Valley News - Jennifer Hauck)

    Nurse Practitioner Maureen Boardman watches while medical student Luca Valle checks Brown’s eyes. (Valley News - Jennifer Hauck) Purchase photo reprints »

  • Medical student Evelyn Bae does a hearing test on Dennis Brown. (Valley News - Jennifer Hauck)

    Medical student Evelyn Bae does a hearing test on Dennis Brown. (Valley News - Jennifer Hauck) Purchase photo reprints »

  • First-year medical student Colin Tasi checks Nancy Tuttle’s tremors, while Nan Cochran, director of the “On Doctoring” course at Dartmouth’s Geisel School of Medicine, looks on. (Valley News - Jennifer Hauck)
  • Nurse Practitioner Maureen Boardman watches while medical student Luca Valle checks Brown’s eyes. (Valley News - Jennifer Hauck)
  • Medical student Evelyn Bae does a hearing test on Dennis Brown. (Valley News - Jennifer Hauck)

It was a routine physical exam, but the young man who was checking Nancy Tuttle’s eyes seemed a little concerned about hurting her. Tuttle told him that he needn’t worry.

“Don’t be afraid,” said Tuttle, a 76-year-old West Lebanon resident. “Don’t be afraid to touch my head or my shoulders.”

The young man, a first-year student at Dartmouth’s Geisel School of Medicine named George Bodziock, thanked her and smiled. He went on to check Tuttle’s hearing and asked questions about her arthritis, which is so severe that her left hand is swollen. She also has a tremor, which causes her hands to shake, and suffers from nerve damage.

These are not the kinds of conditions that Bodziock is used to seeing in class. Typically, he takes medical histories, measures vital signs and hones his skills by examining other classmates, all of them healthy 20-somethings. But recently, Dartmouth has begun soliciting volunteers from around the Upper Valley for a “patient bank,” which includes people from varying ages and conditions who give these doctors-in-training the experience of seeing real medical conditions they wouldn’t ordinarily find in a young and healthy person. The “bank” was established last fall with a gift from the Friedman Family Foundation.

The course, called “On Doctoring,” is the first exposure medical students have to clinical medicine, in which they learn the basics of interviewing and developing relationships with patients, physical examinations, professional and ethical conduct and other fundamental skills.

Being able to see both healthy patients and those with abnormalities helps medical students get to a higher level of thinking, said Terri Eastman, program administrator for the course. It also lets students interact with strangers who are not their peers, forcing them to adapt communication strategies.

“We’re trying to train (students) about the power of the doctor-patient relationship,” said Nan Cochran, the course director and a physician at the Veterans Affairs Medical Center in White River Junction. “It’s the art and science of medicine.”

One recent Wednesday, Tuttle and another volunteer, Dennis Brown, took turns being interviewed and examined in the class of eight students. It was the first time that either had done something like this.

Neither said they were nervous and, in fact, were participating because they thought the social interaction would be good for them.

Brown, a 63-year-old Quechee resident, said he viewed it like a community service.

“I’m not in a position to contribute financially or anything. So it’s contributing a service,” Brown said. “Everybody has got to start somewhere in their learning and I’m a firm believer you can’t learn everything from a textbook.”

A veteran of the U.S. Army, Brown volunteers his time at the VA Hospital as well. But when he saw a flyer for the patient bank last November, he said he thought it might be another opportunity to perform some community service.

He has an outgoing manner and talks freely about his personal habits and health. Brown has a heart murmur, dermatitis, knee problems and high blood pressure, an array of issues that he thought might be useful for medical students to examine.

“I figured I’m a good subject, in terms of the things they might want to look at,” he said.

Brown’s heart murmur is one such example. It’s not a condition that is easy to simulate for students, Cochran said, and so the opportunity to hear one in a live patient would be invaluable.

“There’s no way a cardiac simulator can describe accurately what a heart sounds like,” she said.

Volunteer patients such as Brown and Tuttle also give students an opportunity to hear a different story, said Megan Januska, a 23-year-old first-year medical student. Talking with a 76-year-old woman was more than just a refreshing change of pace from her classmates, however. It was an chance to learn how to take a patient history and pull out the relevant details to their care.

“We have to learn how to examine them and you can really have an ineffective examination if you don’t understand the person first,” she said.

As the students sat with their “patients,” asking questions and checking their vitals, Cochran stood back and observed, interrupting the exam occasionally to ask the student a question or correct their technique when using a tool.

Tuttle and Brown seemed eager to share their stories. They talked about when they first discovered various symptoms and delved into personal details about family and their life experience, answering all the questions asked of them and occasionally offering a little more. Both gave gentle encouragement to the students, with Brown more than once reminding his student physicians that he “won’t break.”

At one point, Tuttle laughed as a slightly startled student stood by her, examining her neck by pressing his fingers beneath her jaw. She assured him that he was doing a fine job.

“You get an ‘A’ in pressing,” she said.

Anyone interested in volunteering for the Patient Bank may contact Terri Eastman at 603-650-1797 or Terri.L.Eastman@Dartmouth.edu.

Chris Fleisher can be reached at 603-727-3229 or cfleisher@vnews.com.