The Art of the Physical Exam

Observe, record, tabulate, communicate. Use your five senses….Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert. Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first. – Sir William Osler

Medicine & Society— our “how to act like a doctor” class— feels as though we are playing doctor much of the time. We all have stethoscopes, but we don’t really know what we are listening for with patients yet. We awkwardly poke and prod each other and standardized patients, without really knowing what we’re feeling. Inspect, auscultate, percuss, and palpate – these are the four main steps we’ve learned so far for the physical exam. I feel that sometimes we are so preoccupied with the auscultation, percussion, and palpation (things that we are anxious about performing correctly or at least in the correct locations) that we forget the first step—inspect.

What can you tell from just looking at a patient? Any rashes, abnormal skin tones, skin lesions or growths? Asymmetry, suspicious cuts or bruising? What can you tell from the patient’s position? Does the patient appear tired, uncomfortable or fidgety? What story is the patient telling you just from their physical presence?

I cannot speak for other medical schools, but I can say that I am thankful that I am at a medical school that has a class that takes the time to teach first-year students the art of taking a complete history and conducting a physical exam – techniques that sometimes seem to be forgotten in the fast-paced and highly-technological American healthcare system of today. I am also thankful that we have the opportunity to practice these ancient skills on standardized patients who have been trained to act as patients and are used to medical students fumbling about awkwardly, instead of actual patients at the hospital or local clinic. Of course, one day soon, we will all hopefully be confident in what we are looking, listening, tapping, and feeling for on patients. But until that day, I am grateful for the opportunity to become acquainted with this tradition that, once learned, can be taken anywhere in the world. No million-dollar machines or tests necessary—just me and my stethoscope. And sometimes, this tradition transcends its diagnostic purpose.

As Abraham Verghese so eloquently writes, “It was like an offering. To preside over the bed of a dying man in his last few hours. I listen, I thump, I don’t even know what I’m listening for. But doing it says: ‘I will never leave you. I will not let you die in pain or alone.’ There’s not a test you can offer that does that.”

Inspiration for this article: http://www.nytimes.com/2010/10/12/health/12profile.html?pagewanted=all&_r=0

 


 

Heidt, Rachel (7-29-13) C2017 CROP

Rachel Heidt

I am originally from Beaufort, South Carolina, and graduated from New York University with my B.A. in Psychology in 2009. Unsure of exactly what I wanted to do with my life, I was fortunate to have the opportunity to work, travel, and volunteer for two years while discovering my desire to become a physician. I lived in Alaska, Belgium, Australia, and Thailand before beginning a one-year post-baccalaureate pre-medical program at Bryn Mawr College in 2011. I spent the past year in Berkeley, California, working for the University of California San Francisco as the analyst for the Division of Hospital Medicine at San Francisco General Hospital, the safety-net hospital for the city of San Francisco. My interests include integrative medicine, global and community health, narrative medicine, and working with underserved populations. Other interests include hiking, yoga, and exploring Greenville and the surrounding areas with my husband. I’m thrilled to be back in my home state and to become a member of the second class at USC School of Medicine Greenville. I look forward to sharing my journey into medical school with you!

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Join the conversation

  • George Maynard - 3 years ago

    Rachel,
    Excellent article. Love the depth of your writing. Keep up the great work.
    Much Joy!
    George

  • Rachel - 3 years ago

    Thank you for your kind and encouraging words George! Hope that you are doing well!
    –Rachel