Not-so-Infectious Infectious Disease

Last Friday I participated in outpatient Infectious Disease hoping to see a rare ricketsial infection, advanced TB or a rare sequalae of HIV. Instead, I took a history of a man with sexual dysfunction. Apparently there is no such thing as specialty clinics for infectious disease at CMC. They do have a few scheduled clinics for HIV, but due to the extraordinary volumes of patients infectious disease physicians are also expected to see general medicine cases also.

After introducing myself to my attending, a patient who spoke broken English pushed a medical chart our direction interrupting what introductions my attending and I could have made. Thinking that this patient must be very sick, I pulled up a chair and listened. To my surprise, the patient leaned towards my attending and began to whisper in his ear. Thinking this must be serious, I began to wonder what was spoken. After a few moments, my attending handed me the chart and said... "He speaks English. Interview him and get a full history and physical. Give a diagnosis and suggest a treatment plan." I was a little stunned. I had not been given this kind of autonomy before in India. The attending escorted me and my patient out of the room. "Come... Come... I will find you a private room." After a moments hesitation, while I fumbled with my medicine manual (blue book) trying to find the infectious disease section and hope for some help, I followed my attending.

In India nothing is private. There are too many people and there is not enough room for privacy. My patient and I sat down behind a blue curtain. As my attending pulled the curtain close, he handed me the chart saying, "the chief complaint is erectile dysfunction. Come back to my office when you are done."

It became obvious during the interview that my patient's broken English and my American accent made hand gesturing and pointing to each other's crotch almost essential for understanding. I will spare the details as they are graphic. After what I thought was as good a history as I could get, I did a cursory examination and reported back to my attending's office relieved that the worst was over--or so I thought. My attending was disappointed that I had not done a genital examination. He pointed out the door handed me the chart and said "do a full physical this time."

By now I think my patient knew that I was a physician-in-training and only pretending to know what I was doing. He asked me what happened. "He wants me to do a genital exam." If you have ever had a dog as a pet, you know that when they are confused they tilt their head to side as if to want more explanation. My patient tilted his head and wrinkled his forehead. "He wants me to see your...." I pointed to my crotch and he immediately understood. He then excused himself to the rest room saying that he would return.

I don't know why he left or what he had to do. Maybe he was as nervous as I was. Or maybe he had needed to go for awhile as it had taken us a long time to understand each other. For any reason, I thought it was strange and wished he would hurry back as I wanted this humiliation over as quickly as possible. When he returned I did the exam.

In his chart I wrote, "circumcised male, no lesions, no ulcers. 2 testicles." Final diagnosis: Erectile Dysfunction likely secondary to anxiety. Recommend Counseling. My attending seemed satisfied.