I am a medical conumdrum

The first year medical students have spent the year working on learning the practical aspects of being a physician. Every doctor has to know how to give basic examinations, such as taking a medical history, cardio-pulmonary or neurological just to name a few. To test what they have learned, UCSF sets up mock-clinical exams for the first year students. So, last Thursday, yesterday and tomorrow, I have and will spend four hours in the afternoon being prodded, poked and touched by first year medical students. I was selected because my friend H. Carrie Chen runs this first year class and knows my medical history and thought I would be interesting for the students to examine because they end up finding things that throw them for a loop.

The first years perform a musco-skeletal exam on me in front of a teaching doctor who evaluates them. As they perform the exam, they are palpating (touching and feeling) the bones, joings and ligaments along my shoulders, back and knee all while asking me if I have any pain. In addition, they ask me to do range of motion exercises as well. I am wearing a hospital gown as we do it, but during some portions the exam, I take it off.

One of the last parts of the exam, is to test for reflexes in the knee and ankle, which I have learned tests for spinal cord function in the L4-L5-S1 area. This is where things get interesting. As they hammer at my knee, nothing happens. It totally throws them for a loop because everything else has been going so well up to that point. After five or six whacks at my knee, the doctor or I will tell them that they are doing it correctly and that I have dimishished reflexes in both areas, bilaterally.

When the exam is done, the doctor, student and I sit and talk about techniques they could have used or if they tried to inspect something in the wrong place. For example the students always miss the biceps tendon. When they say they've found it, I am looking at them knowing that they've TOTALLY FAKED it when they said they found it. But what the doctor asks them to do is to make any other observations about me. What the doctor is trying to get them to do is ask about the huge scar on my left side. Only 25% of the first years even ask about it and if they do, I am allowed then to tell them the story of my accident. Once all that is on the table, the first years have a context for the lack of reflexes because my spinal fusion is at L1-L2-L3 and my reflexes are controlled by the spinal cord below my surgery. The moral of the story for first year doctors? If you look and ask, you may have the answer given to you.