I have been helping with the exams of fourth year medical students, as a simulated patient. (A simulated patient pretends to be a real patient, yes? Good? Right? I have to check to see if the wilful idiocy is catching).
The students know we're not real patients, but they're supposed to act as if we are. Today, I was playing a patient in a very boring, ordinary scenario - a woman who wanted to go on the Pill, but had to take the mini one in order not to exacerbate her migraines. My friend Rebecca was playing someone with bipolar disorder - rather more interesting.
Note: I can slip back into "woman acting" whenever I like, as I did it for so long.
So, a fourth-year med student has been trained in medicine, and in communication skills, yes? Being fourth-year med students, they will have been trained in medicine, for four years?
Out of eighteen students:
- Roughly 50% of them talked about the combined pill instead, under the name "mini pill" or "progesterone only pill"
- Several of these, of course, gave me advice that would almost certainly have resulted in pregnancy, as I would essentially have been having unprotected sex
- Two of them knew the failure rate of the mini pill. The rest made it up, with answers from 0.01% to 5%
- One of them just could not do Key Stage Three level mathematics - two others struggled
- Three of them didn't know the difference between "first day of your period" and "first day of your cycle"
- Two of them told me that I had an increased risk of ectopic pregnancies - FALSE - and one of these talked about the horrors of an ectopic pregnancy in great detail
- One told me that I was likely to have male-pattern hair growth - you know what, FALSE
- Edit: I forgot, "progestrogen" is not a hormone - and it wasn't a slip of the tongue. To this student, the substance under discussion was definitely progestrogen.
To elaborate on the maths:
Student: "The failure rate is (made up percentage that is bollocks)"
Me (in polite ladylike tone) "Er... over what amount of time?"
Student: "The amount of time you take the pill."
Me (in polite ladylike tone) "I mean, is it the possible failure rate in one cycle, or a year, or just an average for all women over all the time they've taken it?
Student: "It's just the failure rate, however long you take it for."
Student: (smirking in patronising manner) "You seem a bit lost. Shall I go through everything again?"
Now, I'm certain that all of those students (about 60% of whom were female) weren't all gay or celibate. Some of them must have wanted to prevent pregnancy at some point? Yes?
I knew all the differences between the two pills, and how they each compared to other methods of contraception. This is because I have used contraception in my life.
The examiner for my station explained to me that medical departments just aren't failing medical students any more, because universities are all competing for artificially high pass rates.
I vaguely knew that this was the case (though honestly, truly, it's not true for my degree course. Despite excellent teaching, we have a high rate of failures and drop-outs, and I haven't got over 60% so far).
It just didn't seem that important, because I'd seen it in disciplines where NOBODY DIES if you are Doin It Rong.
People with complex illnesses (like, actually, bipolar disorder) are often asked why they don't trust doctors. People who have not been ill but have had to go through medical procedures nonetheless, like transsexual people and pregnant women, are often asked why they don't trust doctors. They're asked this with the subtext "Are you a crazy paranoid loon?"
Because... because... oh, never mind.