Brushing Up On The Physical Exam

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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