Did Somebody Call a Doctor - Part One (The "Fun" Version)

I want to share a couple stories with you. Both of them ended up being defining moments in my growth as a medical professional, but for wildly different reasons.

This is the first of those stories.

The year was 2009. It was my last year of chiropractic school, and I was in the student clinic. Most chiropractic programs do this weird thing when it comes to getting your clinical and practical hours – they pretty much throw you to the wolves.

The way the student clinic is set up, is that each student is personally responsible for getting a specific amount of ‘services’ credits, in different categories. You need to do “X” adjustments. You need to do “Y” physical therapy services. You need to do ”Z” new patient exams for patients who have never been to the clinic before.

The new patient exam part, was the trickiest of them all.

If a friend hit their requirements early, they could transfer you that patient, and you could knock out the PT and adjustment requirements. But not the new patient one. That had to be someone who had NEVER been to the clinic, ever.

Now here’s where it gets even more interesting. The style of practice that a student wants to do post-graduation, may not really fit into the model of practice needed to graduate. There may be things you’d never do as a clinician in the real world, that you have to do a ton of to graduate. There may be things that you’d spend a lot of time doing as a clinician in the real world that would get you ZERO credit in chiropractic school.

Maybe you plan on having a practice where you ONLY manually adjust, and refer out the physical therapy. Doesn’t matter. You still need to do the physical therapy in student clinic..

Maybe you plan on having a practice where you don’t want to do passive modalities. Doesn’t matter. You still need to do a certain amount of ultrasound or muscle stim treatments in student clinic.

Maybe you plan on having a practice where you focus exclusively on soft tissue manual therapy. Doesn’t matter. You still need to adjust EVERY patient in student clinic.

For some students, student clinic was set up almost exactly how they planned on practicing in the real world. These students thrived and loved the experience. For other students, student clinic had NOTHING to do with how they planned on practicing in the real world.

I fell into the latter category.

The end of the semester was right around the corner, and I still had a few new patient exams I hadn’t checked off. I was starting to freak out. I was asking everyone I knew if they could help me. I asked if they knew ANYONE who might be interested in coming to the clinic. It was proving difficult, and my stress levels were rising daily.

A big part of the problem I’ve realized in retrospect, is that I have a hard time promoting or selling products that I personally don’t believe in.

I’m sure people could sense that when I’d ask them to become a patient, and my lack of authenticity was probably shining through.

Anyways, a friend came through.

My roommate just moved here, and is in the final round of cuts for the Cowboys cheerleaders. She’s done gymnastics here whole life and her back is a mess, so I’m sure you could help her. She’s also super cute and bubbly, I’m sure you’ll love her!

Exam credit?

And she’s cute and bubbly?

A cute and bubbly POTENTIAL DALLAS COWBOYS cheerleader?

One of the things I found most fascinating about Texas, is that it’s been the first (and to date, only) place I’ve ever been where reality was actually MORE dramatic than the stereotypes. I expected big hair, big trucks, big portion sizes, and big personalities. Now take every one of those stereotypes, and turn the volume up to 11. That’s Texas.

Imagine everything you’d expect from an archetypical Dallas Cowboy cheerleader. Well that’s who ended up walking in for my exam.

Anyways, I run some pre-exam paperwork through my supervising doctor, and he mentions that this exam is going to be “QAd”. Well the “QA” or “Quality Assessment” means the exam would be directly supervised by a HANDFUL of doctors, through one-way glass.

The new patient exam at the school I went to was a two-hour exam. Yep, two hours. Every orthopedic and neurological test you could imagine. Heart sounds, lung sounds, abdominal exam, full review of systems, everything. They wanted us to get our reps in.

Since the exam was so comprehensive, patients were asked to change into a gown and a pair of shorts for the exam (while keeping their underwear on). This is an important part of the story that we will come back to.

Anyways, shortly into the exam I shifted from “barely developed frontal lobe and still obsessed with superhero movies, Moses” to “Ice cold clinical machine, Dr. Bernard”. Both still exist to this day.

(I’ve had more than one patient tell me that when they first met me they thought I was really intense and it took a few visits for them to realize I’m actually NOT just a walking Wikipedia.)

Things are cruising along until we get to the orthopedic exam section.

The patient is lying on her back, and I’m about to perform a straight leg raise. The test looks something like this.

But here’s where it starts getting interesting.

The shorts the school provided for the patient were a loose-fitting basketball short. Something like this:

Shorts that allow you to move freely and easily.

She however, came in already wearing shorts, so decided that hers were fine. And she was wearing something more akin to this:

Fine in most circumstances, depending on the size you choose

This will prove to be important.

Now this may come as news to some of the guys reading this, but I’d bet many of the women reading right now know EXACTLY what I’m about to describe. Depending on the looseness or tightness of a certain pair of shorts or underwear, if you shift your legs a certain way, the seam at the crotch might shift (accidentally or not) to the side, exposing certain “areas”.

And that’s what happened on that faithful Texan summer day.

Mid-exam.

Being observed by a half-dozen doctors.

So NOW let’s revisit the straight leg raise:

Well that’s the first time I’ve come across THIS professionally

Keep in mind, the clinic doctors can’t see what I can see. And neither can the patient. I’d hoped a cool breeze from the A/C unit might have informed her that things had “shifted” so she could fix it, but she kept communicating with me as if nothing had happened.

Don’t you DARE break eye contact, Moses.

My strategy was to say nothing, and hope things would shift back with some positional changes. There were a lot more leg movements that needed to happen, so either things would shift back on their own, or one of the movements would help her realize things were out in the open. At the time, I hadn’t come up with a professional way to say:

“Excuse me ma’am, do you mind adjusting your shorts? Your decision to not wear underwear has left your vulva is unnecessarily and completely exposed, and such exposure is not required at any point during today’s assessment. I’m a chiropractor, not an Ob/Gyn”

Yeah, definitely didn’t have that phrase in my arsenal yet. So next up in the exam protocol: The Patrick/FABER test. It looks like this:

Meanwhile, I’m communicating with the patient this entire time. Asking questions, looking for feedback, and MAINTAINING EYE CONTACT. Meanwhile, the doctors in charge of my professional future are judging me. And I’m the only person with the vantage point to see what’s actually happening.

As I’m sure you can imagine, the shift from the straight leg raise to the FABER test did NOT move things into a better position.

In fact, a much, MUCH worse position.

This continued for the next 15 minutes or so. Changing the patient positions, doing different orthopedic tests, hoping things would shift back to normal, hoping she’d realize. Side-lying, face-down, didn’t matter. Still exposed. The doctors supervising me still can’t see anything.

Finally, about an hour later, the exam is finally over. The patient is sent on her way, and I get to sit down with my supervising doctors to receive some feedback on how it went.

Moses, that was one of the most professional exams we’ve EVER seen from a student. Most students stumble through at least some part of the exam, but you were smooth and steady the whole way through. Especially the orthopedic exam part, looked like you’d done that a million times.

Several years later, I shared this story with one of my best friends and a former roommate of mine named Tom Miller. Now, Tom is a middle school teacher. But not just your average middle school teacher.

He specializes in dropout prevention schools. Schools where under 50% of the students ever end up graduating high school. Schools where a lot of the students either know, or are one degree away from knowing a family member in jail. For the 90s movie buffs, think Michelle Pfeiffer in “Dangerous Minds”.

That's why I know my life is out of luck, FOO’

A lot of these kids like to continuously “test” him, to see what they can get away with. Sometimes it gets intense, but he’s mentioned that it can get pretty funny sometimes.

Enter Tom:

“This kid made a BRILLIANT ‘That’s what she said’ joke the other day, and “Mr. Miller” had to shut it down and get the class under control. Meanwhile “Tom” wanted to give the kid a high five for the brilliant execution. It was a perfectly played joke. But “Tom” and “Mr. Miller” are VERY different people. Shit, I don’t even really like “Mr. Miller”. If Tom and Mr. Miller met at a bar, they probably wouldn’t even be friends.”

I once read a book called the “Alter-Ego Effect” about how different presentations of our personality may suit us better or worse, depending on the circumstances. There’s a time to be Superman, and there’s a time to be Clark Kent. What you bring to the table as a hard-ass CEO, probably shouldn’t be what you bring to the table when you teach your 8 year-old math homework. We bring different identities to different fields of play.

On that day in chiropractic school, I learned viscerally, that “Moses” and “Dr. Bernard” were ENTIRELY different people.

And Dr. Bernard, when pressed, is a machine.

-Moses

Moses BernardMay 22, 2020