Brushing Up On The Physical Exam

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Today is my last day of orientation before beginning residency on Monday! After thinking about which aspects of patient care will be relevant to all my medicine-heavy intern rotations. I arrived at something which has undoubtedly become a lost art as imaging modalities and labs have become more sophisticated – the physical exam.

As a med student, I found the physical exam skills of some of my more “traditional” attendings to be intriguing. Let’s take liver palpation, for example. I’ve seen countless students/residents basically begin feeling for the liver in the right lower abdominal quadrant and work their way up the abdomen. No percussion to give a rough estimate of liver boundaries. No consideration of adjacent musculature which may hinder the examination. I myself am guilty of this on more than one occasion. And then I worked with a physical-exam-savant during my sub-internship who really showed me the benefits of habitually doing things the right way.

Here’s a wonderful excerpt from Clinical Methods: The History, Physical, and Laboratory Examinations with regards to conducting a proper liver exam.

Image Credit: Clinical Methods
Bimanual liver examination (Image: Clinical Methods)

With repetition, this exam takes no longer than 20-30 seconds on most patients, but it can give an experienced practitioner a very good idea of pathology – is the liver capsule inflamed, does the liver feel nodular or smooth… small or large?

Extrapolate this to the other organ systems, and a good physical exam is extremely important. Med school did a great job of teaching me the techniques. It’s time to brush up on them.

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