Rage

In FPC, we had a standardized patient playing the role of Rage, a homeless 17 year old presenting with pain on urination. She was a difficult patient. She did not make eye contact or shake my hand, shouted profanity and banged on the walls. When I first started talking to her, she repeated everything I said back to me like an 8 year old. She played with her gum, making obscene shapes and commenting on it. When asked how many sexual partners she had, she said "a bajillion." She then started hitting on me. When I asked her whether she smoked marijuana, she asked me if I did. When I said no, she told me I was really missing out and that she had some pot and we could get high together. I couldn't get much information from her, and what I did get, I couldn't be certain was true.

It was a really hard interview. I thought I'd be decent at it, but I was wrong. I became irritated (maybe even angry) and I took it out on the patient, becoming authoritarian and even sarcastic rather than empathetic and calm. I felt like I was distancing her, and that her responses of "Yeah, whatever" were simply to placate me. She had all these tools in her arsenal: judging me, being obnoxious, blackmail, coercion, eliciting pity, manipulation. It was very hard for me not to respond in like.

I am not sure how I should have handled the situation or whether any other tactic would have worked better for me. Indeed, my classmates took different strategies: being more passive and playing the role of a peer or playing on her goals and fears in life. But each attempt to communicate with this laconic, emotionally closed, uncooperative patient had its strengths and weaknesses. All in all, this was an excellent exercise in learning to deal with adolescents and all the psychosocial and behavioral issues that come with them. I learned a lot from my supportive classmates; hopefully when I see a real patient in this sort of situation, I will have a better idea of how to proceed.