When my son was 4, he was a standardized patient for our medical school. I was the attentive mother. After four exams, a fifth student began their exam, and my son now being aware of how the exam should proceed. He yelled at the poor student, "You're doing it wrong," You could hear the laughter from the observation room 🤣
@@Julia-lk8jnthey also tend to see the world rather simply, and have not yet fully developed their empathy (which also informs us what other people are doing/planning). In other words, kids are often just like that sometimes
So how did Neurology manage to get through standardized patient training in the first place? I'm guessing he didn't. He found a standardized patient, made them cry, then stepped into their room before anyone knew what had happened.
As an anesthesiologist I only approach neurologists to ask them if they'd like me to put that needle in the patient's spine or do they want to take a sixth pass at it. ZING!
@@Joy21090 In my mom's case, she was already working at the university hospital, and saw an ad. The med school loved getting standardized patients who were already associated with the university in some way because they were already in the system and thus seen as trustworthy. So it's not like this was a full-time job - it was something Mom did to make extra money (3 teenagers in the house - need I say more?).
@@Joy21090 It's also usually not a full time job! The ones at my school work at most two afternoons a week, seeing about 6 students per afternoon. You get trained and offer us feedback and even get to grade us lol
My jaw dropped when I saw who he was testing. Poor med student. I would've ran. My ''Oh No'' count was 6, but honestly I'm surprised the med student didn't have a full blown panic attack and faint. My heart and condolences to you dear med student.
I've learned so much from your videos that I actually flinched and said, "Oh nooooo..." when he pulled out the stethoscope to test the neurologist's reflexes. XD
@@sir.periwinkleton262 The proper instrument to check deep tendon reflexes is with something called a reflex hammer. Its basically a rod with a piece of rubber at one end. People use stethoscopes as a substitute sometimes and it does work but neurologists find it kinda insulting.
The Neurologist is one of the most well fleshed-out characters & Dr. Glauc is too good at condescending burns to have not learned how to dish them in a clinical setting.
well, it might be a stretch, but eyes tecnically are part of the brain, as they evolved directly from it... but that might be my biology maj talking, i dont know if they count as such in medicine.
@@Apostate_ofmind not a stretch at all. Vision assessment and tracking are cornerstones of neurologic health (vestibular, reflexes, neglect, sympathetics, cerebellum, etc), would not shock me that he got into eyeballs after getting tired of neuro egos.
I'll never forget the one time I saw a pediatrician do reflexes on a kid by literally just flicking his wrist/fingers so he would hit the kids in the knee with his knuckle. It worked shockingly well and felt like such a power move to me and I'm genuinely not sure how the neurologist would react to it.
@@takayamuramoto4490 I'm sure it's not as good as a hammer if you're trying to pick up super subtle neurologic signs but when you're doing mostly well child visits and run of the mill sick visits it works well and the kids loved it. Nowadays I can consistently trigger my own patellar reflexes by just flicking the right spot with my finger tips.
I had an obstetrics mentor who did reflexes for pre-eclampsia with her finger tips and a flick of the wrist. It blew my mind then, but I learned it and it works really well when all you're worried about is hyperreflexia.
As someone who loathes toxic behavior, I'm surprised by how much I enjoy the Neurologist. The arrogance and cutting insults amuse me every time. And the teeth. I can't get over them.
At this point I'm almost convinced that this 🤓 would be a neurologist emoji. I'm not fully convinced because the emoji is similing, as opposed to the neurologist.
If this happened to me my strategy could be summarized as "fail and retake hoping that next time I get the usual pleasant 70 year old lady who was bored during retirement"
One of my colleagues forgot his reflex hammer during an osce exam. He ended up karate chopping the patient's tendons for the reflex portion. The examiner and the standardized patient was not impressed 😂
To the non medical people, technically yes you can use the bell of the stethoscope as a reflex hammer. No you should not do it unless you don't have a reflex hammer for some reason. And yes using a stethoscope in an exam is an instant fail. I don't even know the consequences of doing it in front of a neurologist.
Medical students kept stealing my crappy triangle reflex hammers..after 6 just used stethoscope bell on cheap stethoscope as that was borrowed 'for a second ' and never returned at least 4 times a year. I yearned for a good littman, quality calipers,good hammer, Phillips screwdriver, a good penlight , and gel pens with fine tip for most 39 yrs of nursing. Sigh
Honestly, it's better to not even check reflexes than use a stethoscope imo. I've seen one too many residents try to do it, get a minimal response and then just write "2+ bilaterally" before coming in with the ol Tromner and seeing a brisk reflex instead
@@puregsr I was told that in heart there are Purkinje fibers while in cerebellum are Purkinje cells. It's a bit less confusing this way. But maybe 20 years ago they just didn't care are called both of them "cells".
I have this exact exam tomorrow morning. I also showed my neurologist attending First Day of Neurology yesterday (after we had been reviewing consults requests and it felt VERY relevant). He laughed a lot and made me text him the link. He also enjoyed Bill Does a Lumbar Puncture. I will have to show him this one after my standardized patient encounter. 🤣🤓 (PS I am in Kansas and your rural medicine videos are HILARIOUS. 100% would wear a Texaco Mike shirt).
Wonder how his latest batch of moonshine/contrast/sedative is brewing up? I hope your exam went well. Please take care of yourself, and be kind to yourself, for you are worth it and deserve it more than you know.
"You know how they say your life flashes before your eyes right before you die?" "...yeah" "Well what are you seeing right now?" I'm impressed the student just accepted their fate instead of running.
I hope the med student and Bill can offer words of comfort to each other, later over a cup of coffee. The med student definitely needs one to revive himself and Bill, well, he always needs one. They both have been through so much.
A long time ago my med finals paediatric long case was a 16 yr old with pan-hypopituitarism... mum was fantastic and basically saved me and said "Well, they are going to ask you about this and this.." and proceeded to dictate out my history and 'findings'. The only finding I could really say was he didn't have any pubic hair, he was otherwise a normal kid who had been replaced with everything and treated perfectly. How I sweated, but somehow passed all thanks to that beautifully kind mum who saw the absolute terror in my eyes and saved me.
I took a driver's ed test like this once. It's a small thing but you remember it forever. I think the emotional impact of that assistance does more for you than doing it yourself would have done
Once I had a patient in the enfermary (as a med student) that saw me sweating and saved my ass. He had been hospitalized for a long time and had a lot of students passing with him, so he was quite used to the drill. I was passing the case to my preceptor, and she asked me something that I had forgotten to ask. He immediately cut in and said "well, she asked me that already, and I answered that...", I mouthed him a quiet thank you and finished passing his case. The preceptor didn't seem to notice what happened, but to me, who knew that he only intervened for the only thing that I had forgotten to ask, it was clear. He was absolutely awesome. The next day I was with a different patient in his room, and he said "you did great yesterday with your boss! Don't worry, all the students forget something, it's not a big deal, but I noticed you got nervous about it". I also saw him telling other students stuff that they forgot to ask, because he knew the preceptor was going to ask them about it, he asked "you are going to examine my... now right?" when the same group forgot about a certain part of the physical exam. He said, when a student from that group gave a wrong answer to the preceptor that although he had indeed answered the question like this to the student, he had since remembered that the correct answer was another one. I'm pretty sure, although I didn't see that, that the one who confused the answer was the student not him, but he knew that one preceptor was always yelling with us, so he did it to easy things up for my colleague. He was dealing with students attending their first patient and he knew that. He was really nice all around, not just in that way. I really wish that pair hadn't manage to take him from me (long story, they had to cover for me, because I had to help a different doctor and they decided to give me one of the patients that was originally theirs to me when I came back instead of him, and I didn't want to argue), but to be honest, just that first boost of confidence did wonders
As a neurologist and medical educator, a well-weighted Tromner is much easier than a queen square because the queen square hammers are generally lighter so more likely to hurt plus are generally longer so harder to carry…and the triangular Taylor hammer belongs in the trash. (Dejerine hammers are also good though not as readily available.)
I was never able to get reflexes on people with that rubber tomahawk, except patellar sometimes. Finally got a Tromner and holy crap that thing is amazing.
As a family doc, you glance at your patient. If they are speaking clearly and have no obvious facial droops and walked into the exam room without any abnormal gait, they are 95% ok. They are "grossly intact" and good enough to make it another 3 months if they have no specific complaints.
Dude, the ophthalmoscope joke is on point! I can barely see the retina with that thing. "No papilledema is present, I suppose." You should make a video showing how to properly use it.
My favorite standardized patient was one where during the debrief after the encounter he was upset that I didn't ask about his socks which had the logo of his favorite sports team on them. He said it was vital to talk about things like that with your patient to built rapport. He was playing an emergency department patient with an appendix that was about to rupture...
Had my "standing" regular appointment with my primary doc today (side note: GOOD GOD I LOVE THAT GUY!👊 He's proof that excellent docs DO indeed exist. And in a PUBLIC HEALTH CLINIC no less!). We were discussing which surgeons to choose for consult about spine surgery. (Not my first. Or second. Lol) He asked if I was thinking Ortho or Neuro. _Somehow_ the topic of surgeon egos came up. He said "Ortho surgeons are notorious for big egos." No argument there. Then followed with "but Neuro... Neuro surgeons are a 'peculiar' lot. All the ego of an Ortho but with a special twist." All I could picture was Neuro EXACTLY as portrayed in this video... and couldn't stop giggling. The BEST part? I told my doc if he wanted to see accurate & hilarious stereotypes of each specialty in medicine, look to Dr Glauck's vids. Doc got a yuuuuge grin and said "I LOVE THAT GUY!"🤣🤣🤣 Already a fan. ☺️ (Of course.)🥰
I love the way your videos are full of excruciating embarrassment. They are therapeutic for (the viewer's) anxiety I swear! I keep them as little treats to break up a worrisome life. Thanks Dr G.
My workroom is practically next to the oncology and the neurology. I'm on friendly terms with some of the doctors. One of the neurologists wanted to trick their new med students and asked, if I would let them check my reflexes (I am missing the ones in my knees, ellbows, hands, ancles, all that stuff since havin GBS last year, the doc treated me). At first they were a little panicky, thinking they were doing sonething wrong. Than the doc asked them what if they weren't. After they did ask the questions if I had pain and other symptoms etc. we did tell them it was "normal" at the moment for me and explained my medical story. In the end it was only kinda mean from him and rather interesting for the med students :) I did get slight bruises from some rather harsh hammering on my knees though :')
Oooh, after my spinal fusion l1-l3, I have no more reflexes in my knees ankles or elbows. It's freaky watching students and doctors freak out and then just to tell them "Yo, that's been my norm since I was 16, and I was told that it was fine and normal". Them: "Who the hell told you that? That's not normal!"
I was a Standardized Patient, and also taught Doctoring Skills. Those poor med students were so nervous! It was lovely to see their growth and progression over time. It's an amazing program!
I went and looked up different reflex hammers after you mentioned the Queen square in a recent video. Had no idea there were so many, if I had been a neurologist instead of a business analyst I know I would have gone with the trômner.
He absolutely could have, he was doing finger to nose testing which is already going beyond what most physicians do in the PE... But the reflexes-with-a-stethoscope tactic is a death sentence, and rightly so.
The same thing happened to me during my physiotherapy for cardiopulmonary test. Prof said he would find us some standerd patient. Test day, stepped in, it was him who laid on the patient bed lol
Neuro is too funny. I was a neurologist clerk at the va as a kid. Those guys were 😎 I took all the breaks and kept the charts updated and the coffee hot.
When I was a med student,my standardized patient was the neurologist too....after I opened the curtain to see him as a patient,I almost forgot everything due to an episode of panic attack
Doctors have Drill Sargent's, they just don't yell, drag you or make you do physical exercise as punishment. Actually, if you teamed up with a military RU-vidr, like the real life drill Sargent on the channel "Angry Cops", that could be a cool video on who burns down their subordinates the most or comparing how they destroy a trainee. Great sketch BTW. You're awesome doc. We'll done man, you legend.
i mean, for all the grief neuro gave, he did kind of help him along. he's very much an intensive care bear, trying to bring out true potential with tough love
This reminds me exactly of how I was treated in biology labs when a superior was teaching me something new .. then later on I found myself doing the same thing sometimes to the undergrad assistants when I was in grad school. 🤦🏻♀️
"You know how your life flashes before your eyes before you die? What are you seeing right now?" That's right up there with "What do you want me to tell your parents?" as a death threat
I am going on my second year as an SP in Canada. I love it! Thank god we have actors and non-MDs do SP work.... I don't think neurology would have passed the testing to become one:P
I am a huge fan! Even though I have had math and science challenges and not even close to the medical profession, I understand and relate to the feelings of uncertainty and fears of punishment and failure in high stakes situations! Excellent comedic acting! You are consistently brilliant! 🏆👏🏼👏🏼Your vids brighten my day! 🤗 😆.
I’m sorry but “You know how they say your life flashes before your eyes before you die?” ‘Yeah?’ “Well what are you seeing right now?” Deserves more attention for how raw that line is.
"- You know how they say your life flashes before your eyes before you die? - Yeah? - Well, what are you seeing right now?" I'm soo borrowing this for my next D&D villain xD
Today was my first day in intern year! And i just watch your "intern's first order" video now. That was so nice. I was like that whole day :)) they said my voice cracked while asking how to do sth. But i loved it. And i love your videos and your opinions abt things that you mention in your videos(covid, masks, surgeons, healthcare etc ). You bring me a wide smile with your videos. But not just for fun, i also see you as a role model too, the things you mention on your videos are so true.Thank you so much Dr.G !!💙 And again neurologist is my favvv😁😁
You know they say life flashes before your eyes before you die? What are you seeing right now? This line is so SAVAGE!!! I will use it on my employees from now on xD
I audibly gasped seeing Neurology as the standardized patient. Didn’t need the rest of it to know the poor med student was going to come out emotionally mangled 😭
I remember not finding the point of my nose with my finger during a neurological exam once. Probably the scariest moment of my life. The doctor's stare and awkward silence following that, boy, I thought I was going to be put down. I'm kind relieved to see not only I find neurologists probably the most intimidating doctors of all.
I had to do the test where I had to keep my balance and not fall forward while my neurologist lightly pushed me on the back. I got nervous and overcompensated so he pushed me on the back and I fell BACKWARD.
So funny recognising the different references to the cranial nerve exam. Really it's the not the patients you have to worry about but the examiners. Some of them really don't have a problem telling you how poorly you did in the exam room...
how hard can a neuroexam be? sees the "standardized patient" nevermind he is so dead and failing this. pulls out stethoscope* ok if he hasnt died yet, he definitely dead now.
Every time the neurologist appears in one of these skits I am more and more grateful that our primary neuro professor might be the best teacher to ever live.
As a current med student, even though I've been an EMT for 7 years and treated sick patients and doesn't usually get nervous, that big nervous gulp before walking into the SP room is a legit haha
I've seen reflexes checked with a stethoscope. I think it was about 30 years ago when a family medicine resident used because he didn't have his little rubber hammer. You hold the tubing about 4 inches from the bell and hit the desired tendon with the edge of that rounded bell. It worked quite will for him.
@@goldensunrayspone That's what one of the more experienced spinal surgeons in my area does, just a real distinct tap/flick with two fingers. Never saw him pick up a hammer as far as I remember. It takes some training to get it right but once you've got it down it works surprisingly well
@@mjbonnin Completely understandable. in anesthesia I've never had the need to check DTRs. The reflex that I deal with - doesn't require a hammer to evaluate - the one that tries to evacuate an empty stomach in the PACU.
