Sunday, September 23, 2007

Deep breath, deep breath, deep breath, deep breath, ok, breathe normally.

If you read the title, you've just experienced what it's like to have me perform a physical exam on you. Just envision me listening to each side of your back on the bottom, then each side on the top, then to your chest. I've done it so much that I catch myself doing it like a zombie sometimes.

Which is good, because it's important to get a rhythm going with the physical exam. This is for several reasons:
Reason 1: You don't want the patient to suspect you don't really know what you're doing.
Reason 2: You usually feel like a giant wonk, so it's easy to get flustered, which also tends to result in some patient uncertainty. If you have a system you tend not to get flustered, unless they have a really obscene tattoo or something (not that uncommon).
Reason 3: It's amazing how easy it is to forget to check things that you should be checking. For example, if someone has a URI (upper respiratory infection), you should listen to the lungs, and then often we throw in a heart listen for free, 'cause we're in the neighborhood, then you are supposed to look in their ears, their throat, and their nose (Believe me, it's as gross as it sounds. I used to always worry when the doctor looked in my nose that it was gross and embarrassing, and as it turns out, I was right. It is gross and embarrassing.). But for at least the first two weeks I would be looking in the ears, trying so hard to see something, anything, and I would get focused on that and inevitably forget to look in either the throat or the nose. If I had my rhythm down then, I wouldn't have had that problem.

The neuro exam is even worse, 'cause there's a bazillion things you are technically supposed to check, but most doctors only check about a million of them, but you don't always know which ones the doctor you're working with thinks are important enough to do. Then there's the abdominal exam, which sucks on 1) fat people, 2) people who currently have abdominal pain, or 3) both (this accounts for most of the patients I saw). It sucks because you feel really strange pushing around on this GIANT stomach and moving it around (I am not exaggerating), and you feel really bad pushing on it and making them cry out in pain (also not exaggerating).

Anyway I was thinking about the physical exam because I took that stupid Family Medicine test on Friday, the videotape one (see last post), and it sucked gluteus. It was actually four patients, and I think I did so badly that I am expecting a call any day now from the medical school advising me to go into a field more suited to my particular style of physical exam, such as herding cattle or mud wrestling. I guess I can at least be glad it's over, and I get about two months to sweat about my grade since it takes forever to get it back. This coming week I have a nice, short, relaxed rotation, followed by three weeks of vacation bliss. There will be painting of my grandmother's house, yes, but there will also be sleeping. And beer.

I'll be back when I have something interesting to say about resuscitating people. In the meantime, if you see me coming with a stethoscope, run the other way.

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