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Physical Exam Tips




Hey what’s going on guys? Welcome to another video for physicianassistantboards.com

What I want to do today is something a little bit different.  I don’t really want to talk medicine per say today and I don’t want to go over a disease process.  What I want to do is give you some tips that you can take and apply to your physical exam.

Now it’s very important that you figure out a way that you can do this consistently every single time the exact same way. Why is it important to do your physical exam the exact same way every single time? Well there are a couple of reasons why: the very first reason is, if you’re not looking for something you’re not going to find it.

So when you have a patient that comes in for a routine physical, a lot of times they’re not going to tell you they have problems.  A lot of times they are not going to tell you that they feel bad, they’re going to say ,”I’m just here to make sure everything is ok.”   Meaning, that if you take their word and don’t do a complete physical exam, you’re going to miss things. You’re going to miss that enlarged goiter. You’re going to miss that murmur, you’re going to miss those decreased breath sounds right? So you have to make sure that you actually do the complete physical exam in doing the exact same way.

Because what starts to happen, if you don’t do it the same way, you start to miss some steps. Then you actually have to start thinking, did I do this? Did I do that?  If you get into the habit of doing it the same way every single time, then you go on auto pilot and you don’t have to think about it. Now if you don’t have to think about something, that gives you another benefit.  That means you actually get to do things a lot faster, because you can actually start to do things in a very process-orientated manner. Right?

What I do is start from the head and I will work my way down the body. I will make sure I can do everything with the patient sitting, and then I will lie down and start doing the physical exam that requires them to lie down. The least amount of steps you take, the faster it’s going to be.  The least amount of work that you can actually provide, or the least amount of work that the patient needs to do, the better your physical exam is going to be and the faster it’s going to be.

And why is time so important? Well, as a student you’re probably told you have about 15 minutes per patient, right? In reality you don’t have those 15 minutes; you probably have around 5-10 minutes per patient. So if you can save your time doing the physical exam, it’s going to be huge. But again, it’s not about the time per say. Yes, that’s an added benefit, but most importantly getting into the habit with doing things the exact same way is what’s really going to give you those results, it’s really going to help you actually find things; it’s going to help you identify problems that the patient might not have otherwise noted.

You would be surprised how many times I’m doing a routine physical exam and we start to have some abdominal discomfort with palpation that they did not notice before. Next thing you know, we have to work these things up and it can actually turn out to be something serious.

So like I said before, if you’re not looking for something, you’re not going to find it. And if you do different steps every single time, then you have to start thinking about things.   You have to start thinking did I do this, did I do that? The other great thing about doing it in a process-orientated manner is if you don’t have to think about “did I do this or did I do that” your brain can actually start thinking about other things.

You can actually start to multitask. You can actually start think why is this goiter enlarged as you’re doing other physical exams, and then you start putting the pieces of the puzzle together. Then I hear Bruit then I hear that he’s a little bit tachycardic. Now you diagnose hyperthyroidism right? So you can actually start to put other pieces of the puzzle together while you’re doing the physical exam and not necessarily have to write everything down, leave the exam room, and then try and put the pieces of the puzzle together after the fact.

So, very important if you’re not looking for something, you’re not going to find it. Before I get out of here, I want to leave you with a very quick quote, and the quote goes something like this..

“It’s not what we do some of the times that makes us successful, or changes our lives, but rather it’s what we do consistently”

Very important, consistency plays a huge part in your life.  Make sure that you develop these habits early on, and that way, once you get to clinical practice, everything is just smooth.

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