A few weeks ago, I
posted about clinical coaches and said that I'd mention a particularly dodgy one; it all started out in the first week of first year...
Along with my five classmates, we met our first clinical coach. She was lovely. We talked about the meaning of the word touch. Sometimes touch is gentle, empowering and comforting. Sometimes, touch can be cold, rough, fearsome and harrowing. She impressed upon us the importance of using the right touch whilst examining a patient. After eight weeks, we moved on.
On this particular Tuesday, Dr Rotter was waiting for us. A man in his early sixties, he sat in the corner in his blue shirt, moleskins and cowboy boots with his legs crossed and his comb-over slightly ruffled. He introduced himself briefly, saying that he'd "Done it all" and was "here now'" in a somewhat forceful and bitter tone. He then proceeded to give us his version of life the universe and everything, making know his distaste for hospitals, the minister of health, long working hours and the tough life of a doctor, adjusting his small spectacles on his round face throughout. He expounded his views on women in medicine and the role of indigenous Australians within society. He mentioned he'd worked in the Army for many years, and been rural for several. I, for one, was not surprised. He had, so far, epitomised all the typical negative stereotypes associated with either. Except one. Then he asked us which high schools we'd attended.
So, he says, what am I supposed to teach you lot? We briefly explained that the current block was on the Respiratory system; we'd had at least three weeks of classes on such, and in a months time we needed to be able to competently run through this aspect of a physical in front of an examiner. He informed us that there was very little to the Respiratory exam at all, really, and that we'd have a talk about it first. Have you heard of asthma, he asked.
Dr Rotter finally got the message that he needed to teach us some physical examination
techniques. Someone at the SoM had given him
Talley & O'Connor, and when we arrived for session two, he was flicking through it, enthralled. I got the feeling it was the first textbook he'd read in about fifteen years. You should read this one, he said. We had. In fact, we were so disillusioned from the first session, we'd held a 'catch-up' session amongst ourselves. Self-directed learning win. Again, rather than actively teaching us how to perfect our examination techniques us, Dr Rotter began to wax lyrical about Pulmonary embolus, and rattled of some risk factors. He talked about weight being a factor, and pointed to us in turn, descibing our body types. Thin, normal, normal, thick, thin. Yup. He said a girl in my group had a 'thick' body type. Unprovoked. Then he told us that it would be harder to examine her and not to bother. In fact, he said, women are hard to examine because they have breasts. Then he mockingly told a story from his medical school days to illustrate his point. He must have been such a hero to have 'examined' one of the ten girls in his class.
In the third session, Rotter arrived ranting more than usual. He'd stormed up and down the corridor like a petulant child cursing about not being paid. He also berated the medical school and it's teaching practices, and suggested we'd all get a better education by going to Med school in Samoa. Then, against all odds, he decided to actually demonstrate just how examinations roll. He selected the other male in the group (Daredevil) and sat him on the couch, and got him to take off his shirt. He began to tell us about the importance of General Inspection, noting that Daredevil was skinny and then moving to examine Daredevil's hands. He neglected to mention the Daredevil's ten-inch median sternotomy scar. We had, by now, established Rotter as both offensive
and incomptent.
At this point we complained to the school; the guy was obviously not fit to be teaching, and I, for one, was going to spend as little time in his presence as possible. At the meeting, it was also mentioned that he'd patted one of the girls on the bum. Not for the last time, unfortunately.
Our fourth session was with real patients. This 'clinical visit' was a big treat for us fresh and enthusiastic first years. We arrived at the private nursing facility at the appointed hour, to be greeted by the unit manager and her friendly do. She was most pleased to have a doctor looking around, because the regular clinical wasn't due until Friday. I knew the regular clinician from my pharmacy work, and whilst nearing the end of his professional life, he was a pretty switched on cat and a nice guy. Rotter would be late as he was still with his other group of students.
Forty-five minutes later, a blaise Dr Rotter strides around the corner, ushering the other group out. So, he says, I see you've met Nurse Wilson, he mocked, she's a very special lady, Guffaw Guffaw. Follow me. And he walks off. We catch up and he tells us that he's a long way behind time and that we're going to see one of the "old biddies" on the second floor, because she had some good lungs for listening. If we were lucky, we might see two patients, he said. But remember,
"THEYRE ALL REALLY HARD OF HEARING, SO MAKE SURE YOU GET RIGHT INTO THEIR EARS!" he demonstrated into Lickety-split's ear.
Rotter strides into the patient's room without knocking;
"Hullo dearie, it's me again. I've brought some more students."
A frail lady in her eighties looks a little frightened and the slowly recognises Dr Rotter. She begins to say, "Oh, well, dinner...."
"Yes! I know that dinner is soon. We won't be long. It'll just be the same as before." Rotter booms.
The lady begins unbuttoning her shirt.
"No No. Ha ha! Haw haw! You don't need to do
that just yet."
My colleagues and I are shocked. This isn't right. We crowd around the woman's chair and Daredevil, begins to examine her. When, at the appropriate time, he asked Mrs. Z to remover her shirt just enough, and the patient says "Pardon?" Rotter mocks him and reaches for her buttons with one hand and sleeves for the other. Wonderwoman says; "Perhaps we should close the door?", and extricates herself from the circle. To this Rotter replies,
"What on earth for? No-one's going to walk past who cares." We soon completed our examination and walked outside. Rotter decides that the best place to talk about this patient is in the common area with five other residents a full four feet away.
Rotter notes that the next patient has changed her jumper since the last group, and when she removes it she's not wearing a brassiere. Rotter is flustered, and asks her to "cover yourself up, love". She put on a thin singlet, and I begin to listen to her lungs. The next patient also had some resiratory crackles. She, too, was a thin religious lady whose only sins were a seventy-pack year history of smoking.
"Gee, it's hot in here. Where's the aircon remote?" He grabs it and dials the temperature down to 18 degrees C. The already frail and wasted patient begins to shiver about twenty seconds later. Batman subtly retrieves the remote and switches the A/C off.
In doing so, Batman had moved herself out of the circle. Rotter was unhappy with the new dynamic and man-handles each of us into the best position. Wonderwoman is seething. She sort of steps back. "Oh," says Rotter, "you go there then, there's a good girl.", and he guides Batman forward. Batman walks out to use the bathroom. It was later revealed that Rotter's method of 'encouraging' a step forward was a pat on the rear end.
We'd flown through the first two examination (out of a desire to keep these poor ladies away from Rotter), so we were given a 'treat', and allowed to see a third elderly patient. Rotter took a cursory history, which elicited the question "I think that one of my medicine's making me sick. Could it be giving me nausea?"
Rotter: "No, love, your medicines are to
help you."
Patient: "Have you seen my list?"
Rotter: "No, I'm not familiar with your case. But your medicine is to help, so just keep taking it, alright, dearie."
Rotter summarises his disgracefully inept history "So, this patient reports some muscle weakness and arthritis, but as we've heard, her cardio and respiratory systems are just fine." Meantime, I have noticed both several Ventolin inhalers, and a
glyceryltrinitrate spray at her bedside table. Rotter, smugly, asks if there's anything else we would have asked. Big mistake, Doc.
Capt. Atopic: "Ms. Y, I notice you have a pink bottle there [indicating]. What's that one for?"
Ms Y: "Of course lovey, I take that one when my neck and shoulders get really sore."
Me: "And how often is that?"
Ms Y: "About once a week."
Me: "Have you ever been to hospital for it?"
Ms Y: "Of course, my doctors said that I have something called 'Angina', I was there about a month ago for two weeks, and they said..."
Rotter [interrupting]: "Well, these things are hard to diagnose. The doctors there are treating it as cardiovascular, but it may be that she's pulled a sternomastiod." He spent the next ten minutes trying to save face, including mentioning that I'd gotten lucky in seeing the medicine. Not surprisingly, this annoyed me even more. I'm usually a very respectful guy. Particularly when it comes to the elder and the wiser of the world. I quietly read through the patient's chart and decided I'd put the boot it.
We moved to a corner area and sat around to discuss the patient. He mentioned her Angina and arthritis, and asks if there are any questions. The others look awkward. I say,
"Dr. Rotter, I noticed that the patient had a pack of ibuprofen next to her bed. She's already on 1200mg of ibuprofen daily, as well as a diuretic and an ACE inhibitor. The extra ibuprofen puts her at an increased risk of renal failure. Shouldn't you mention something to her?"
Rotter: "Well, Capt., as you know, there are many different combinations of drugs and we sometimes prescribe them."
Me: "I understand that Dr Rotter, it's just that if this were my patient, I would consider this to be a significant interaction."
Rotter: "I'm sure her doctor knows about it."
Me: "I'm pretty sure he doesn't, that's a supermarket-sized brand of ibuprofen."
Rotter: "Well, she's not my patient."
I was flabbergasted. Despite his rudeness, sleaziness and incompetence, for me, this line told me more about Rotter than anything else before. He was a mysoginist, reticent, moronic self-protector, who didn't give two shits about anyone but him. He was fired from the SoM soon after this clinical visit. Hopefully he's been deregistered by now.
