Hacks to Build Patient Rapport | The Short Coat Podcast 414
By David Etler
May 25, 2022
0:00 / 58:38
Riley Behan-Bush00:32

I

Jessica De Haan00:33

do remember once having this, like, um, he was a retired. Surgeon who was just angry at everyone , and there was a complication with a feeding tube in his stomach and And I have nobody wanted to touch them though. And I just remembered, I just went in there and turned on my charm and I. I can't tell you what I said. by the time he left the clinic, he was smiling. Yeah. Oh, you are just cute. A little

Listener Josh00:56

honey, so biscuit

Dave Etler00:58

Welcome back to the short coat podcast. The show that gives you an honest look at medical school. Of the university of Iowa Carver college of medicine. I remember that. I can't tell you how many people who I have met, who have listened to the show and then they've come and interviewed here and been like, oh, I had no idea.

The show has done here.

Riley Behan-Bush01:22

First line of the first.

Aline Sandouk01:25

And the last line actually, is this

Dave Etler01:27

happens more

Jessica De Haan01:28

often than you might think. How many commercials do you watch? You're like, that was funny. And then you're like, what

Riley Behan-Bush01:32

was the.

Dave Etler01:33

Yeah. Well, okay.

Riley Behan-Bush01:36

That's you gotta say it louder.

Dave Etler01:40

Uh I'm the king of Dave Etler would that doesn't matter right now because I've got some real live medical students here in the studio.

Do you all want to introduce yourselves using a cool moniker? Like I did like, like choose your own. Moniker on the

Riley Behan-Bush01:54

fly. I needed three days advanced. I wouldn't be able to do this out. Let's do it. How about the standard

Hannah Van Ert02:00

comedian? I was

Aline Sandouk02:02

gonna say, um, all scrubs this is all I'm wearing from now on. They're amazing.

I don't know why we wear anything else.

Dave Etler02:11

MD/PhD. All scrubs. I like that,

Jessica De Haan02:16

uh, Prego Jess, because I feel like I've been pregnant for half of medical school

fitting moniker, and I'm going into OB GYN. So

Dave Etler02:26

Jessica Hahn, M three. Yeah.

Jessica De Haan02:29

Right.

Riley Behan-Bush02:30

You're basically I'm for senior student. So that should

Dave Etler02:34

be. Riley being

Riley Behan-Bush02:35

Bush constant stress Riley

Hannah Van Ert02:42

started off with consonant.

Riley Behan-Bush02:44

She's stressed. I was going to say constantly stress, but that I took a back of staff to stress, stress.

Hannah Van Ert02:51

You can feel like the stress

Riley Behan-Bush02:52

response hair, Riley, generally you're happy person, but like stress. Sometimes my word that I use overall.

Listener Josh03:02

Fair.

Dave Etler03:02

Fair enough. Fair enough. What about you?

A MD/PhD student. Hannah Vanner.

Hannah Van Ert03:07

Oh, Lord. I'm first of all, I think I'm today. I'm a granny Hanny. I've been feeling very old. Ladyish I've been knitting a lot. I've been sewing a lot and I have two cats. So I don't know. I'm just embracing the like 75 year old lady life.

Riley Behan-Bush03:23

Mild

Dave Etler03:23

urinary incontinence. No,

Riley Behan-Bush03:25

thank

Hannah Van Ert03:26

God.

Riley Behan-Bush03:27

Pelvic. I still should still have that going for

Hannah Van Ert03:31

me. Excellent. Thank you for putting that on the board. You have an identity crisis when you're post-menopausal like the rest of us. No, no, no. It's all. It's all good. I am fully identify as an old lady and I'm here. I'm here for.

Dave Etler03:47

I forgot to do something.

Riley Behan-Bush03:48

Oh yeah.

It's really cool. Art. The other day you posted something. What was your art that you just

Hannah Van Ert03:53

post? Like, what are you talking about? Talking about how I don't do art. Quote unquote, don't do art. So I crossed it. So it's like a form of embroidery

Riley Behan-Bush04:01

and it wasn't, it was stunning

Hannah Van Ert04:03

for the art context. Trying to con my mom and a framing it for me.

So, and I bet I bet your shoe. Well, I just have to ask for it for a gift, but it's this like, oh, I don't even know. I think it's probably like two feet by a foot and it's this beautiful, like art deco. Lady, it looked like

Riley Behan-Bush04:21

Musha

Hannah Van Ert04:23

right. Oh, that's a great quote. I got off Pinterest. I got the power of Pinterest, there's like a, a paired thing that goes with it. And the other ladies, like looking towards each other. So I bet. Her and then frame both of them and like gold frames and then hang them somewhere in my house. That would be incredible.

And just never stopped talking about the fact like anytime anyone comes through my house,

Riley Behan-Bush04:42

be like I made that. I that's my thing. That is the only reason that I want to get into DIY things is for the. Absolutely on humblebrag being like, yeah, I made that bed. Yeah. That shelf hung that I feel such pride being the one in my household that does the like carpentry and by carpentry, I mean like nail and wall and problem solving.

I mean, I, you know, get one engineering degree and you can feel like you can do anything. I cannot do anything. I got a Hacksaw the other day. I know enough to know about safety, but not. Like to know about, to know, to go get the things that will keep me safe. So I just had a hand on it, sag away on the side of a car, like a coffee table.

It was chaos. I mean, absolute chaos, but I knew enough to know hand needs to stay away. Victim once a victim of, no,

Hannah Van Ert05:33

this is not a Hacksaw. This is a cryostat. So I was slicing placental tissue, the cryostat and I did the VR. I did a very dumb thing and it, I really bad. And then I refuse to tell anyone about it because it is a it's it's cold.

It's a deli slicer. Yes. But it's not set up like a deli. It's basically a very, very sharp blade that can, and it's a, it's a piece of machinery and you can dig. You can tell that. Thick, you want it to slice this piece of tissue. So it's capable of forming these very, very, very thin slices of tissue that's embedded in this like plastic-y material.

And I was trying to get the gunk off the blade with the

Riley Behan-Bush06:12

paper towels term.

Dave Etler06:14

Yes, the science

Riley Behan-Bush06:16

and the science,

Hannah Van Ert06:17

the science guy. And I sliced my finger open and I felt so embarrassed. And it was in the lab of a person who has an MD degree, like an MD. So instead of telling anyone about it, I started cleaning up and like, Get out of there before someone noticed that I was like profusely bleeding from

Riley Behan-Bush06:34

you, put the bloody Kim wipes way down.

So it's not very absorbable at all.

Hannah Van Ert06:41

And he caught me as I was leaving the lab. He's like, let's go. Cause I had it wrapped up really thick in that paper towel. And he's like, where are you going? And I was like, oh,

Dave Etler06:49

I just, I just made an unplanned contribution to.

Riley Behan-Bush06:54

I got to go to the blood center right now.

Well, and my mind wouldn't

Hannah Van Ert06:58

stop bleeding into my mind. I'm like, I can't extinguish it from a finger cut. Right?

Riley Behan-Bush07:05

It

Hannah Van Ert07:05

was what you just

Jessica De Haan07:06

shared though, is like the beginning. I feel if so many Marvel movies

Riley Behan-Bush07:11

have powers right now, you probably aren't aware, oh man. Central powers powers. But anyway, I am. It's

Hannah Van Ert07:18

you

Dave Etler07:19

have the, you now have the power potentially. You now have the power to transform into, you know, cause follow my logic here.

You now have the power to transform into whatever you want because. Uh, you know, maybe there were some fetal stem cells.

Jessica De Haan07:34

Yeah. She actually,

Aline Sandouk07:35

we didn't know she had a scar because she spontaneously regenerated

Hannah Van Ert07:39

your right over like two weeks. Yeah, sure.

Aline Sandouk07:43

You can brag here. It's okay.

Riley Behan-Bush07:45

So sorry. That was don't look up.

The turnover of skin cells don't look it up. It was fast. I eventually did stop bleeding.

Hannah Van Ert07:52

Yeah,

Jessica De Haan07:53

I just realized you all have your MD/PhD MSTP track people. So I'm your least educated

Hannah Van Ert07:59

medical students. I

Riley Behan-Bush08:00

would not say that that's true at all. I just called myself stress Riley, get stressed by knowing a lot of things.

Aline Sandouk08:08

Yes. I'm pretty expensive training and momming,

Hannah Van Ert08:11

obviously. So I was in, I was telling Dave or no, Jessica asked me what my PhD was in and I'm like, well, technically it's immunology, but you ask me anything about T-cells and I can't tell you, I don't think they're real. You asked me I haven't, I haven't seen it.

Nothing. Those are fighting words.

Riley Behan-Bush08:28

I don't really, I don't care

Aline Sandouk08:29

what any of these other

Riley Behan-Bush08:30

people, it's funny because me not knowing enough, I literally thought there was a theory that T cells don't exist. The paper was dying, you know, it's

Hannah Van Ert08:39

an ongoing joke and immunology,

Dave Etler08:42

pre-print a study, not peer

Aline Sandouk08:44

reviewed.

There is someone in the department who like, uh, Kevin. Who complains a lot about some guys, some random guy. I don't know where, who thinks that, uh, macrophages aren't a thing that dendritic cells and macrophages are actually the same cell type. Just no one's ever caught the intermediary cell before they divide.

Hannah Van Ert09:05

Oh, damn

Aline Sandouk09:05

gets real matter. But it's like, how dare, like calling it a question, basically all of his work, but yeah. Scientists are ornery.

Dave Etler09:18

It was a wonderful discussion. Thank you.

Riley Behan-Bush09:20

You told us to keep talking

Dave Etler09:23

and you did

Riley Behan-Bush09:26

again, need to be told we're doing great.

Dave Etler09:29

All right. I finally have what I was looking for. Um, Josh called the SEP listener line at 3, 4 7 short CT. You're welcome to do that to listeners. Uh he's in his clinical years and he has discovered a hack for grumpy patients.

Let's hear from Josh.

Listener Josh09:49

I started code. My name is Josh Magoo. I was wondering if you guys could talk about little Quip that you used to talk to patients that just make them laugh or feel good, or just sound like a person instead of like rattling off fevers chills started as a breath, nausea, vomiting, diarrhea, like a robot, like we're training.

Some things that were previous. So my name's Josh, but whenever a patient's like, what's your name? And I always say Josh or Joshua, if I'm in trouble Kilz every time, or if you see a patient and you're like, oh, how are you? And they say, oh, you know about how, or you just say like, oh, well I should be asking you that question, you know, or this is probably the best one.

If you ever have like a curmudgeonly, like 80 year old lady, and they're just pissed to be there for whatever. If you have any reason to like, hold their hand, like you could say, you're looking for cap refill or rashes or blah, blah, blah. But there's something about holding a patient's hand and then they just love you.

So I've kind of collected a couple of those after rotating with attendings. I was wondering if you guys have any good ones as well, uh, make this process a clerk. That's a little more bearable. Have

Dave Etler11:00

a good one. Thanks for calling Josh. Uh, All of you have some clinical, some clinical experience at this point, but, uh, Alena, Jessica, and especially you just because you worked as a physician assistant before you, long before you came to medical school, um, do you have any standard phrases that you use to put patients at their ease when you walk in the door, do you do this?

I

Jessica De Haan11:26

can't. He's definitely like on-point. I can't think if I always have. Fixed phrase that I would use. Um, but I tried to turn on my Southern charm a little bit. And that does work, especially with the elderly people. Like he said, they do, they love

Riley Behan-Bush11:48

I

Jessica De Haan11:48

do remember once having this, like, um, he was a retired. Surgeon who was like, he had a, I think a peg this was years ago and nobody else wanted to see him because he was just angry at everyone who said, um, like a tube, a feeding tube in his stomach, and there was a complication with it and he didn't want to drive out to where it needed to be fixed and, and somebody needed to do something for him.

And I have nobody wanted to touch them though. And I just remembered, I just went in there and turned on my charm and I. I can't tell you what I said. It was more like how I said it. And then like, by the time he left the clinic, he was smiling. Yeah. Oh, you are just cute. A little

Listener Josh12:28

biscuits. So honey, so biscuit and everyone's like, what did

Jessica De Haan12:33

you

Riley Behan-Bush12:33

do in there?

I

Jessica De Haan12:34

was like, I don't know, just turned on the charm.

Aline Sandouk12:38

The nerves are charming is, say what you will about the south, but they are adorable. I tell you every single doctor. A lot of, yes. Like we're just trying to help ya. And a lot of like ins just leaving off the G of like, well, what are you thinking? And that's it, all of it.

And it is immediately very disarming just as a hundred percent.

Jessica De Haan12:55

And I don't have like a Southern accent, you know, but I have family members to do so I can turn it on. I need.

Hannah Van Ert13:01

You can also use like sexism and misogyny to your advantage. This is like when I was in the VA as a nursing student, you like the nurse will walk in.

Yeah. Yeah. So you like your, your nurse that you were falling for the day would walk in and be like, Hey, I've got a nursing student before you, she needs to practice an Ivy. Like, what do you think? Can she practice on you? And the little, like the old. Navy veterans who are like, oh, I'll love it. Any little, pretty thing.

Do whatever she wants to one. You gross, but second. Thank you. Yeah,

Riley Behan-Bush13:31

I guess I'll just take it for the opportunity.

Hannah Van Ert13:33

Yeah. Until they start asking you questions about your personal life. And then you're like slowly back. The room you are going to do that stuff for real

Aline Sandouk13:40

fast. You're like, oh, well we're done.

Can't answer that question.

Hannah Van Ert13:43

This is how much, yeah.

Dave Etler13:45

You could make up details about your personal life. I'd just have them ready or make them up on the fly.

Riley Behan-Bush13:51

Right. I'm such a bad liar.

Hannah Van Ert13:54

Some

Aline Sandouk13:54

nurses wear wedding bands just to avoid getting sin on. Cause I mean, before 1990, I think that was the dead giveaway.

They're like, oh, okay, well that's, can't come out of this one. So it's effective.

Hannah Van Ert14:07

I think. Yeah. I

Riley Behan-Bush14:08

feel like there's a lot of lines that like kind of yield from like misogyny or something that it's like, oh, I'm just the cute little girl. And it's like, nah, I'm also like, you know, well-educated and I'm here to do my job, but like when you're in the VA, it's just kinda like works to your advantage to get these patients.

Like you, it's not great. I'm not happy about it. And they can't even think of like specific examples, but like, there's definitely been times where it's. They'll say something sexist and it's just like, ah, and then they're like, okay, well, at least they're not backing. I'd probably should, you know, say other things, but

Hannah Van Ert14:40

yeah,

Aline Sandouk14:41

it's not a, mean-spirited, it's a little weird, but like, you have to remember that the guys, the VAR relics from a

Riley Behan-Bush14:48

different site, you're talking to your eight year old grandpa.

Like, you're not gonna be like, grandpa, don't say that. Well, and the,

Hannah Van Ert14:52

like the ones that I experienced too, they were still very respectful. Like it was very much like, and they are of that generation. They tend to ask fewer questions or doubt their medical providers. Like they are still of that generation.

That's like, whatever you say, doc. Oh, sure. Um, but yeah, they do throw in some of that, like, so sometimes you're able to walk in. It's a thin

Aline Sandouk15:13

line and it's really hard to articulate, but there's a moment where it crosses over from like folksy to like, okay, you need to stop

Hannah Van Ert15:22

that's enough. You know,

Riley Behan-Bush15:23

that is, that is true.

And that's why it's hard to articulate, which is like, it's very situational, these kinds of interactions. And I guess we are talking about maybe the population. Would walk on that fine line. There's also like a whole host of like, when you're in a pediatric clinic, like ask any kid about the toy they're playing with and they're going to instantly love you, like ask any kid about any show that you've heard that kids are into these days.

Cause your melon,

Hannah Van Ert15:46

like your favorite pop patrol. Exactly. And so I think

Riley Behan-Bush15:48

those things like just learning about the kind of people you're working with and then like start asking them about the thing that it works more so with children, but teenagers ask them about. They always, they would roll their eyes at me, but I'd be like, yeah, I'm on tic-tac.

I felt really cool.

So what would I really like Josh's idea of having a stock phrase.

Jessica De Haan16:23

Um, I have stock phrases that, but they're not like funny. I mean, it's like I walk in the room and, you know, as the med student being like, you know, I'm here just to make sure we're on the same page. Uh, you know, Dr.

So-and-so is going to come in and follow up, but I'm just here to get things started with you if that's okay. So they don't feel like I'm totally wasting their time, but that's not like a humorous stock phrase. That's just like a awkward initiation stock phrase, um, to where they put up with me. Um, so I like the idea of maybe starting off with something more humorous, but I can't think of something for you hit really good on like, Adolescents.

I'm like, we talked about elderly people. So what if they're like 25 to 60, you know, what do we

Riley Behan-Bush17:03

do with that rate? I feel like the, I don't know. It's hard because it's not often the like intro phrase, but I think asking any person who has explored. Interest in talking about their children, about their children like that.

I mean, I probably have gotten myself into like five to 10 minute conversations with patients that I had seen about their children. And like they're telling me every ounce of their lives and I'm like, all right, well, really happy we're having this conversation. This is not where I thought it would go.

But like, it is really interesting. And sometimes you learn a lot about those people and they're more likely to open up to you. And sometimes I'll come back in and check on them later and they'd like, have photos ready to show me of their dog or their child. I like going deeper into those personal questions, even though it's not necessarily your job and you don't always have the time, but I want to phrase, I don't know about the intro.

Aline Sandouk17:49

Gary Goldman has this amazing bit about being at the grocery store and having someone like cut in line. I don't know what, but he was like, if you want to get a bunch of old ladies on your side, just call them girls. He's like, come on girls. Well army. That's true. When I walk into a room and I call someone like young man or young lady, like that immediately makes them feel, but they're like, no, one's said that in here.

That's

Jessica De Haan18:15

pretty sweet. So

Dave Etler18:17

I, but I, I think that the equip that relies on the characteristic of the person. In the interim, the other person in the interaction is a bit risky.

Aline Sandouk18:26

Yeah. It's very, you know, the problem is that there's not a one size fits all. And I think that's what we're all getting at is like, you have to like a good comedian, you have to read the room.

Some people are not in the mood to joke around. And so you'll make a joke and it falls flat and you're like, all right, right. So business. Um, but then some people, I don't know, I try to let the patient determine that like, if they start joking around, I'm like, all right, this is going to be fun. So then we, you know, but it just depends.

I don't really

Dave Etler18:51

think you should tell the story that you shared with me. I don't know if I should. I really think you should really think you should. It's a good story. I'll tell you what, share this story. Yeah, right.

Riley Behan-Bush19:07

I will personally, I will delete it and

Dave Etler19:10

then I will delete it. If you, upon reflection, you have to give it the weekend upon reflection.

Decide that again. Okay.

Aline Sandouk19:22

Um, so you guys remember in the first year when, uh, for the SPS, they would have a day or whatever, where they would bring SPS with like specific physical exam findings, and you'd kind of rotate between the rooms. Um, it's made me sweat, just thinking about it's so embarrassing to look back, but you know what audience, friends, I grew.

Let me just preface that. I realize what I did wrong and I have grown. Beyond that. But anyway, um, one of the patients there had RA like pretty bad rheumatoid arthritis, rheumatoid arthritis, so had like the Swan neck finger and like the think Bouchard's nodes and things like

Dave Etler19:59

that. I'm

Jessica De Haan20:01

translating. Yeah.

Like,

Aline Sandouk20:03

yeah, exactly. Like very, um, I'm trying to use a non-valid word, but like, Fingers shaped in such a way that deviates significantly from the normal, let's just put it that way. Um, and he seemed really good human and I have this habit sometimes of when I look back on moments in my life that like, we're totally fine at the moment, especially on days when I'm feeling very self-conscious I apply this lens of like looking for a bad thing I did, and then beating myself up.

You know about it for years, but I remember that we were joking around and then at one point, all I remember is that we were joking around and then I said something like, uh, do you ever use your hands to like, mess with people or like play pranks on people? And I remember the, he laughed along with that, but then like my brain inserted.

Before his left, where there was like a flash of discover on his face. And I was like, you idiot. Why would you, why would you point out that his hands are so disfigured that he should bring people with them?

Jessica De Haan21:04

And

Listener Josh21:05

I

Dave Etler21:07

we've all been there.

Riley Behan-Bush21:10

experiences of my life that I've done, stuff like that. Have a moment.

I want to take the words

Hannah Van Ert21:16

back. This was funny to me and my brain, but shouldn't,

Dave Etler21:20

or even just like I have these moments like distributed throughout my life. It's I sort of think of it as just a layer of. Stupidity. That's been sprinkled to an even eighth inch thick across my entire existence where I've said something that was just or done something that was just cringe worthy.

And years later, I'll be sitting there like watching. Television or whatever, and it'll occur to me and I'll be like,

Riley Behan-Bush21:48

yeah.

Jessica De Haan21:50

Or it hits you really like laughing at some character. Who's just so oblivious to themselves. And you're like, that was me.

Dave Etler21:57

I mean, it's fine.

Aline Sandouk21:59

I'm sure he was like this bitch and then moved on

Hannah Van Ert22:04

positive.

Aline Sandouk22:04

I, it woke me up from sleep in the middle of the night where I was like, oh, put it on. Throw it on the pile, right? Let's start the whole movie of all the dumb shit I've ever said, but he probably moved on immediately. I'm

Hannah Van Ert22:15

sure. Well, she signed up for this job. I'm sure he did move on immediately. Especially if,

Listener Josh22:20

if it was me,

Dave Etler22:21

I know if it was me, I would be like, first of all, I probably would have been using my Michelle and hands to do.

Listener Josh22:35

on my finger.

Jessica De Haan22:37

That's

Aline Sandouk22:37

exactly the . You could have a TV show or you just did

Hannah Van Ert22:42

that all day long. We're at Halloween. Like he'd be, that'd be the best, like the best one, a house walking around all

Riley Behan-Bush22:48

by. I just think of like, when you're around any child, like accidentally running into a pole, as people do where they like try to hit their head and then he's like, oh my God, the possibilities are endless.

My

Hannah Van Ert22:59

grandpa has these scars in his thigh. And when I was six, he told me he got shot in the thigh. And so I asked him about it, like 10 years later, I was like, Hey grandpa, tell me the story of how you got shot. And he looked at me, he was like, what are you talking about? I'm like, you got shot. And he's like, you believed that.

I guess he had like osteomyelitis, elderly

Aline Sandouk23:18

people are shifting. Thank you, Hannah.

Jessica De Haan23:21

They've

Dave Etler23:21

gotten used to that. We, you know, we, elderly people have got used to our deformities and our little physical issues. Yeah. I mean, that's why I say it's risky.

Aline Sandouk23:34

And so it looks, sometimes it pays off big time. People are like, like on the worst day of their lives, they're like, I just laughed.

Everything's going to be fine stir. Right. But

Hannah Van Ert23:43

the people who are in that space to use comedy to cope. Yeah. Some people want to do.

Aline Sandouk23:48

Yeah. So I've grown. I've never said that again to someone, but

Dave Etler23:54

I wish if you want to see a LeeAnn's face right now, and if this survives, if this survives. Um, if this survives the weekend for

Hannah Van Ert24:07

the record that I

Riley Behan-Bush24:07

think we could do a whole show of anonymous tips of justice.

Absolutely cringe, worthy things. Us as medical students have said to people, things that I've said

Jessica De Haan24:16

and done that you shouldn't

Riley Behan-Bush24:17

listeners,

Dave Etler24:18

that could be a whole thing, support, Alene, support Aleen, and all of us who have

Aline Sandouk24:25

done you be so much cooler about this than I was expecting. I thought you were going to be like, really?

We don't want to, we don't want to be your

Riley Behan-Bush24:32

friend anymore because it was just

Jessica De Haan24:35

and

Dave Etler24:35

support supported lean, and everybody out there who has. Sat up in bed in the middle of the night and said to themselves, what the fuck is wrong with you to themselves?

Riley Behan-Bush24:50

Tell us your story. Yeah. It's like, I have moments to this day that like, I wasn't trying to.

Uh, trying to figure out comedy and it is forever ingrained in my brain. How absolutely like scum of the earth person. I was for a single sentence that I just vomited in. Then I was like, I want to reel it back right away. Cause I can see this hurt someone. And I thought it was going to be funny. And I now.

That is not funny. Do you still get like the

Hannah Van Ert25:16

F the flush, like the hot sheets in the hot years? I get that, and I can't think of a specific example right now, but I, it's a very universal human experience that I think we all wake up in the, I'll

Dave Etler25:27

be more open about these

Riley Behan-Bush25:29

experiences. I love that the flesh, uh, to go on an embarrassing, speaking of

Dave Etler25:34

the flesh,

Riley Behan-Bush25:36

the flesh safely funnier.

No. So speaking of embarrassing SP stories, I was doing a standardized patient exam that we have to do to be created. And at the end of it, the SPS often give you feedback. And in this experience, I often as a person who gets embarrassed, like we all do, I get very flushed on my chest and up through my neck, my face is.

My neck down is not, I often will wear turtlenecks to these events to avoid this specific experience. One I've had like friends of mine call me out for it. Like they're like, yo, you did really well. Like you look really red though. And I'm like, don't say it, but after this SP experience, Honey, are you okay?

And like, I don't say it, like, I'm not outwardly nervous. Like my tone is usually fine. I don't have like a different vibrato, but like I just get red and she was like, are you okay? Do you need like a glass of water is like, I'm fine. Like, I didn't know how to explain to this person who is my patient, but it's also not like, I'm really okay.

Forever been embarrassed now, and I will often wear turtlenecks. I'm probably red right now are a little rat in

Hannah Van Ert26:51

my read right now, your body,

Riley Behan-Bush26:53

my body does me dirty. And some people call me out for it suddenly. I'm very sad about it. It just happens to

Dave Etler26:59

everybody, I think, but in the less visible way, like I like some tea sometimes even when I'm doing the show, which I do every single week.

And so I should be used to every once in a while. I'm like sweat my ass off for reasons that I. Th that are not clear to me. Um, but it's just something about being on stage or something like that, which is the situation that you're in. When you're working

Jessica De Haan27:19

with

these,

Riley Behan-Bush27:20

he betrays you.

Aline Sandouk27:22

There was a guy in my first year of school that I, that I started med school with that I remember in like one of our first few small groups.

He suddenly developed a stutter. And I remember I was just talking to him afterwards and he, thank God. I didn't bring it up. He brought it up and he was like, I don't know why I'm stuttering all of a sudden I'm like, did you have a stutter before? And he's like, yeah, but like, I went to speech therapy for it.

I was like, maybe you're just a little stressed down. He was like, but I don't feel stressed. And like, your body is telling you you're stressed out. Like, like whatever defense mechanism you put up to like train your body to. You know, whatever the mechanism of stuttering is, I was like those, those defenses break down when you're stressed in a way you don't even have

Jessica De Haan28:00

any, we had like the blepharospasm.

I'm fine. I'm fine. I'm fine. My, my eyelids just, I don't know what's

Riley Behan-Bush28:07

going on through didactic

Hannah Van Ert28:10

consistently. And it was always because I had. I was not sleeping. That's my trigger. Yeah. I

Riley Behan-Bush28:15

get the lot, I got two size in a row on my pediatrics rotation. One of which has not gone away. It has turned into just scar tissue.

So

Hannah Van Ert28:24

yeah, I don't notice it. It makes, you

Riley Behan-Bush28:26

know, it's, it'll look like. Inflamed when my eyes get really dry, but usually it's like small enough that nobody really notices, but yeah. And I had like, I wasn't sure what was going on again. Another embarrassing thing to have to text your head resident. Like, Hey, I woke up and my eyes swollen shut.

Like, I don't know what I should do. She's like probably a style, but you should go get it checked out and. Yeah, it's just

Jessica De Haan28:49

chaos. Start wearing mouth guards at night. Cause I noticed I was waking up and my teeth were sore because I was clenching and I'm like, why am I clenching? Oh, it's just probably like the way I'm manifesting my stress again.

You think like, I know I don't feel stress, but your body is telling you. There's something going on.

Riley Behan-Bush29:09

Oh yeah. The adult acne comes reared. Its ugly head. It's like you thought you were done.

Hannah Van Ert29:15

J K well take it back. It's the

Riley Behan-Bush29:18

deep, like deep seated the three weekers. Cystic acne. Thank

Hannah Van Ert29:24

God I going back to like that.

Why do you have to tell me this? Like I have shaky hands just at baseline. My whole face. Shakes like leaf, like we drink our coffee in the morning.

Riley Behan-Bush29:34

We're all like this only surgeons too, right? No war must be

Hannah Van Ert29:38

a mess and no, but that's the thing, like, we're all like a lot of my family is medical ish. So like my mom is an x-ray tech, so she used to start a lot of IVs and I was an art and like, I can do find

Dave Etler29:50

moments or slightly blurry.

Riley Behan-Bush29:53

No, she times it exactly

Hannah Van Ert29:55

right. But, um, where I was going with this as I was doing a suturing clinic recently, and I know my handshake and I always tell people, cause I've just learned that you just got to tell people because otherwise they think you're nervous. And part of it is true. Like part of it is I don't want people watching over my shoulder and she me, so it's a suturing clinic and she's watching me suture.

It's an MD here. As soon as she was done watching me suture, she stands up and she goes, so it's normal for your hands to shake to like the whole class. And I'm like, you, wow. And she's like, there's ways to get around it. You know, like don't have a lot of caffeine or just exercise and eat regular. I'm like, do you know.

Talk to like don't

Riley Behan-Bush30:34

exercise or eat,

Hannah Van Ert30:38

right. And exercise that will suddenly make your hands drinking

Riley Behan-Bush30:41

caffeine. And I was like, do you realize who you're talking to?

Dave Etler30:47

But anyway, good advice. Let me go get a coffee. So I can really, I

Jessica De Haan30:51

was on or rotation recently. I won't say which one. Um, and the fellow was going to hand off to a senior resident.

And basically was like, show me your hands. And he put his hands out and they were trembling and she's like, Hmm, that's not bad. Okay. Here you go. And I was just like, okay, this is how we roll. This is like a common experience then. And it made me feel a little

Riley Behan-Bush31:13

bit better, you know, it does make me feel better.

Well,

Hannah Van Ert31:15

I think the thing, like we do a lot, like I do a lot of fine motor stuff in lab and there do things like if I know I'm doing a lot. Mouse surgeries that day or whatever. I won't have like the biggest coffee or I'll wait until after my surgeries, but then there's other

Riley Behan-Bush31:29

thing that I could do well, and I get

Hannah Van Ert31:31

raging headache because I'm addicted to caffeine, but I mean, there's also like adaptations.

You can do, like, I use a lot of like supporting hand gestures or, you know, you like take your time and use your breath and like all these things and to have. So eerie, and I'll tell you who it is later, but I don't want the world to house. We're going to talk some shit, but just trying to teach. But she did it in a very, in a way that I felt like it was very kind of catty.

And I was

Riley Behan-Bush31:57

like, oh, I like observation would always have like coaches that would do this. C one player make a bad pass and then it would be like a learning experience, learning experience, like a teaching moment. Let's make this into a teaching moment when it's very obvious that it's like the one person's mistake and now you're calling out the entirety of it.

And I

Hannah Van Ert32:18

know about it. Like I live with these things,

Riley Behan-Bush32:20

Speaking of lab stuff, you know, pipetting into like 96, well plates, first of all, your eyes crossed.

And then second of all, it's just like, you know, it takes quite a bit of like fine motor skills to like, make sure you're in the right. Uh, well, and so I was showing an undergrad, this new technique and she had never learned it. And I obviously had my morning coffee because. Psychopath and I'm showing right now, you know, I'm a little shaky one because she's watching me too, because I'm highly caffeinated.

Cause my grad student. Um, and I'm like, yeah, you know, sometimes your hands might shake it's okay. Like just make sure you're guiding it into the right wall and just like, keep, keep track of it. I was like, yeah. Do you ever have cavities. No, and I go good for you think you're better than me. And I was like, I probably shouldn't have said that to make her feel bad now for not having chasm, then a cringe moment.

You're like, I'm so sorry. I'm so sorry, please. It's okay. You don't have to drink it. I

Hannah Van Ert33:13

didn't until med school, I got through all of nursing school without school started and I was like, holy fuck. I'm never going to get through this. And now I'm completely addicted. Yeah.

Aline Sandouk33:24

Yeah, I would've, I would've made the same joke.

Like, well, keep it yourself then you don't need

Hannah Van Ert33:29

to

Riley Behan-Bush33:29

brag about, and then I took it back. I was like, oh, whatever, it looks good bread that I wasn't good for. You genuinely like, like

Jessica De Haan33:38

diluting. I do like half decaf now. And so I'm like, okay, like I'm still getting something, but it's not so potent. And that if I go without, I don't get the withdrawal headache.

Riley Behan-Bush33:47

Yeah. I think that's a jaw. Headache is not so fun or I'll get the overly caffeinated headache. It's literally it's

Hannah Van Ert33:55

you're so caffeinated. You're like dehydrating

Jessica De Haan33:58

therapeutic. Yeah. But going back to what you were saying, the self-deprecating, I think that's kind of where Josh was hitting on with his comment about.

She and I'm in trouble. He's like, yeah. Yeah, Josh, when I'm in trouble, like he'd make fun of himself. And that's the same thing. Cause you can't always rely on like, whether your patient's going to like take your comment the right way or not. If you're joking. Uh, I've definitely had instances where I made a joke.

I'll tell you mine. Are you ready? Yeah. Okay. So mine was, I had a gentleman who was a diabetic and he was coming in for some kind of. Lab test follow up on it. And he didn't, um, he didn't eat breakfast that morning. Cause I think he really wanted to have good numbers or something, which

Aline Sandouk34:37

you shouldn't do because he also took his Metformin.

Jessica De Haan34:40

So I'm in the room with them and this guy has big, I mean, he's. At least 300 anymore, um, pounds. And so, and he starts going down and I, and I was in clinic clothes. I was all like dressed up and my heels on