Wednesday, November 28, 2007

Day One of the Physical Exam

So it was pretty much a shit show.

Silly me. I thought our very first physical diagnosis session with our preceptors would include some demonstration, some guidelines, you know, some INSTRUCTION seeing as we've never ever done this on anyone ever.

Sure we poked and prodded each other a month or so ago, but we didn't know what on Earth we were doing. We were just giggling nervously like fools wondering if we would have to disrobe in front of 10 of our classmates and a random proctor. Up until this point we've had a single lecture each week over the past six weeks covering various aspects of the physical exam. I... just don't see how that qualifies as learning how to do it. I mean, maybe this is just me, but to learn a physical exam I would expect some physicality thrown into it. Like say, touching a patient.

Which is what I thought these sessions were going to be about.

I envisioned our preceptor palpating a liver edge, keeping their hand on a patient's abdomen and dragging my hand to where theirs is saying, "Here. Feel that? THAT is what liver feels like." Or showing me where to put my stethoscope and saying, "Listen. Hear that swooshing? THAT'S mitral regurgitation." Obviously I'm an ignorant fool who expects to be spoon fed.

We showed up to meet our preceptor and all he said to us was, "Alright. Well. Here are your patients. I'll give you an hour and a half to do the full history and physical, then you can present to me and I'll check your findings."





Green as green can be. And I don't know if you missed the memo from the frog, but IT AIN'T EASY.


I can say with the utmost confidence that my eyes have never been larger, the pit of my stomach never fallen faster, my insecurity never more florid than when he said those words all no nonsense and posthaste.

If there's one thing I did learn today, it wasn't how to palpate an abdomen or percuss a diaphragmatic excursion or observe the apical impulse of the heart, no no... I learned how to suck it up and dive right in. I learned that when an attending says jump, you say how high, and that it doesn't matter if you don't have legs or have feet nailed to the floor or are in an anti-gravity environment, you FIND a way to jump.

I may have also learned that it's not what we call tactful to ask a blind woman to read from your visual acuity card.

I have a long way to go.

1 comment:

  1. Okay, sorry to post soooo long after the fact, but I just discovered your blog and am having a good time reading my way through it.

    That said. *Sigh* As a future patient, I'm bummed to hear about this sink or swim approach to learning about how to handle yourself around a patient's body. I mean, you're right that you DO have to learn to "suck it up and jump right in" and that's an insanely important lesson no matter what you're going to do in life. But Christ, no wonder 90% of the doctors I go to have no bedside manner. Who has the wherewithall to develop it when you gotta sink or swim?

    I'm gonna be a lot more appreciative of MDs that manage to be mildly pleasant, and I'm going to kiss the feet of those who find a way to be comforting and empathetic.