The Physical Exam – Med Student Over Easy

While we have all done our OSCEs in medical school and at some point learned how to do all of the components of a complete physical exam, have you ever wondered how seasoned physicians choose which parts of the physical exam to focus on in the ED? In this episode, Med Student Over Easy hosts Patricia and Kaitlin are joined by EM Over Easy host Drew to discuss the importance of the focused physical exam and how to master it.

• Undifferentiated patients will need a broader exam.
• Focused complaint = more focused exam.
  • But also be careful not to miss a secondary problem.
• Commit to learning how to do the exam correctly in school, so that you perform it correctly in practice.
• Most important part of the physical exam is doing the physical exam as it was intended.
  • Can be difficult in some of our environments, like lobby medicine, when you have someone in a chair.
• Common pitfalls:
  • Student and residents not being honest about the exam that they did.
    • Sometimes it’s because they are embarrassed they didn’t think to do that part of the exam, but always better to be honest about not doing it than to lie.
    • Sometimes it’s because they don’t know that they are doing an exam incorrectly.
      • If you need help, ask!
• Make sure you explain why you think an exam is important, especially sensitive exams, prior to giving patients the option to decline the exam.
• There is a lot you can learn from observing the patient.
  • The way they are breathing, what their skin looks like, etc.
• There is also a lot you can learn by watching others do their exams.
• For the more vague the complaint
  • History is huge and physical exam augments.
  • Walk your patients!
  • Look at the med list
• Pelvic and rectal exams:
  • Plan on doing it if the patient is coming in for a pelvic or rectal complaint.
    • May not always need it in first trimester vaginal spotting, but until you become more experienced, plan on doing the exam.
• Pediatric pearl:
  • Engage the parents.

Take Home Points:

• Hone in on the physical exam on all of your rotations because in the ED we need to know how to do the focused exams that all the specialties do.
• Do the exam how it was intended to be done.

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