Quality Of Patient Histories And Physical Examinations: Fill & Download for Free

A DETAILED HISTORY AND PHYSICAL EXAMINATION ARE STILL THE CORNERSTONE OF QUALITY MEDICINE.Since the dawn of time, in our attempt to improve one another's condition we have talked, listened, touched, and felt in order to gather information.A whole-body MRI is amazing at what it does, but it cannot accomplish a lot of what a proper and thorough physical examination can.Magnetic resonance reveals specific qualities of internal body structures but it does so out of context. The context is constructed using the history and examination and they are just as important.In the case of an alert and communicative patient the examination is a chance to interact and communicate with him. A good clinician starts his (or her) assessment the instant he patient walks into the room, before a single word is spoken:Age, gender, height, weight, body mass index; Posture, level of mobility/motor control/agility/coordination/grip strength, hydration, general nutritional status; Smoking, drinking and drug use status; Medication side-effects and allergies; Alertness, level of stress/anxiety/depression; Sensory status: mental/visual and hearing acuity as well as comprehension; Speech, mentation/concentration; Socio-economic class/educational level, profession, degree of social support; Obvious physical signs suggestive, or specific of, hundreds of genetic diseases as well as of diseases involving the skin, immune system, heart, lungs, liver, kidneys, intestines, skeleton, muscles, thyroid, adrenal glands, pituitary gland, brain, eyes, blood, and overall metabolism of trace metals and vitamins and many many more... and all of this before the patient even sits down to be examined.Upon a thorough examination (with no technology other the basic pocket stethoscope, otoscope/ophthalmoscope) one can get an idea of things such as raised intracranial pressure, increased right atrial pressure in the heart, valvular heart disease, fluid in the lungs or in the abdominal cavity, gall stones in the gall bladder, impending death from an abdominal aortic aneurysm, a fracture of the base of the skull, a narrowing on the aorta, a dysfunctional cerebellum, retinal defects, eye cancer, a compressed nerve inside the skull, a stroke, not to mention a huge proportion of what may be damaged after any kind of injury.A huge plus of the examination is that the patient's mental status is assessed and an invaluable rapport can be established with him based on how the doctor interacts with him. Rapport gives patients relief, reassurance, hope, motivation, trust and is a central part of the healing process. What is the point of pinpointing the exact location of the brain tumor if you fail to explain what such lesion means and you fail to reassure the patient and he goes and jumps in front of a bus thinking he was doomed anyway?In short, nothing in the real world trumps the cost/benefit value of a knowledgeable and experienced doctor listening and examining a patient.

In the seventies of the last century, med students and young docs were so impressed with all the technical advances made e.g. the development of echo(cardio)graphy, CT, MRI and other impressive feats of medical technology, that they forgot that to be a good doctor one should first look at the patient, after taking a history including a social history, and a physical examination which often didn't bring much, think of a differential diagnosis after which we could think of which tests, some using these amazing tools, should be requested.So first look at the person in front of you, after that use all the technology we need to do our work.This is even harder to do when working on an intensive care unit where monitoring and care utilizes a lot of high tech equipment. The temptation is very strong to just look at the (bad quality) chest X-ray instead of listening to the lungs and heart of the very sick patient lying in this bed in front of you, for you to listen to the back part of the lungs for which the patient would need to be hauled upright and supported at both sides by nurses and other people around because they are too weak to sit own their own.Don't make the mistake a lot of young eager docs do:Belly ache (Often an irritable bowel syndrome)? Abdominal CT!Headache (Often a tension headache)? Brain MRI!Panicky and claiming patients makes acquiescing an easy way out, instead of the difficult and often unpleasant task of explaining to the patient why these exams aren't necessary ("So you can by just looking at me rule out a tumor, doc?").This approach dehumanize the patient in front of you: a case of belly ache, a case of pneumonia, instead of a 70 yo ex laborer with new onset abdominal pains who would merit a lot more attention than someone who has had these chronic complains for years without anybody ever finding any pathology.

Chronic fatigue syndrome (CFS) has been a controversial but it is a disease on a spectrum from mild to severe. People with moderate or severe CFS are unable to work due to impaired functioning. People with severe CFS may have very poor quality of life and spend most of their time lying down as mild stimulation/ stress causes relapse.It has been considered as psychosomatic because patients present with a cluster of symptoms (including fatigue) which vary from person to person and often have a normal physical examination. A doctor may believe symptoms are caused wholly by a mental health problem while the patient may only experience physical symptoms which are debilitating. This has caused mistrust between doctors and patients. Alexithymia (reduced emotional awareness) may be more common in people with CFS. There may also be a history of C/PTSD.Fibromyalgia and postural orthostatic tachycardia syndrome (POTS) are possible coexisting conditions.The disease can be triggered by an infection, emotional trauma/stress, physical trauma, surgery /anaesthesia, a hormonal imbalance, chemotherapy or other medication. It sometimes runs in families so there may be genetic or epigenetic influences.It's main characteristic is post exertional malaise. All symptoms may worsen with over exertion physically, mentally or with stress.https://www.researchgate.net/publication/308808662_Differences_in_alexithymia_and_emotional_awareness_in_exhaustion_syndrome_and_chronic_fatigue_syndromeCorticosteroids given during acute viral infection may trigger myalgic encephalomyelitis