Student S Name Physical Examination: Fill & Download for Free

Before we started our clinical rotations in our third year of medical school, one of our instructors cheerfully reminded us-"Just remember, there is no one on the team less important than you!"With that pep-talk out of the way, we joined the teams on our internal medicine, surgery, pediatrics, psychiatry, neurology, and family practice rotations.A medical students primary job is to learn….and hopefully to not actively make everyone's lives harder. As a medical student you are free to write orders in the chart, but no nurse will act on them until they get cosigned by your resident. You will interview patients and conduct physical examinations and write up long and detailed history and physicals. Your intern or resident will generally sign this and add a little note of their own.No matter how great a job you do interviewing your patient, trust that the moment your resident enters the room, the patient will volunteer some critical piece of information that they withheld until now. You will look and feel like a dumbass. This will happen almost daily.As an intern, you now have an MD or DO behind your name. It is your first year in residency. You still have a lot to learn. You will make some super dumb mistakes. You may tell the nurse to give a medicine that doesn't make sense (or necessarily even exist). Be kind to the nurses. You may have academic knowledge they lack, but they have loads more experience than you, and a completely different skill set. They can help you out or make your life hell. Your choice.As a resident you have completed medical school and your intern year. As you get into your third and fourth years of residency you now have a great deal of knowledge and skill. Nurses that once mocked your intern year dumbassery now rush to find you during an emergency. You're still gaining experience, but hopefully you are now mostly competent and safe.The only thing you lack in your chief years of residency, is how it feels to be all alone. Even as the chief resident, you still have an attending to call to help you when the s#*t hits the fan. You can't know how it feels to be without this, or how you will respond to being without it, until you leave residency and are alone in your new hospital one night during an emergency.But that's the purpose of residency, to get you to a place where YOU can you handle being the end of the line.

A2A: Various reasons for doctors standing on the right side of patient during examination (primarily tradition).On the very first day of my clinical rotation our medical officer cried out: ‘Always examine the patient from the right side’. I asked him why it was so. Unsurprisingly, ‘traditions’ he remarked. I have always found this mind set of accepting things as they are without any sound reasoning bizarre. Traditions are always based on some reasoning. Still we choose not to bother ourselves to look for the reasoning and take the easier way out, which is ignoring to question them at all.Some people say we stand on the right as ‘it gives the doctor more manoeuvrability to examine with his right hand’ (10). Then, my question is: why do left-handed people stand on the right side as well? Or has the medical profession got something against the left-handed population now? The answer to why we always have to stand on the right side of the patient while examining him still evades me.Why do doctors need to stand at the right side of patients while examining themMedical Aspects Taken for GrantedMohammad Ahad Qayyum, Ahmad Ayaz Sabri, and Fawad Aslam†Author information ► Copyright and License information ►This article has been cited by other articles in PMC.It is quite extraordinary how the knowledge of certain aspects of medicine such as understanding medical etymology, symbols and history are not stressed upon during our medical training. These aspects are in fact responsible for forming the basis of our identity as medical practitioners, the ignorance of which is rather unfortunate because, in my experience, I have found these topics to be extremely potent in enhancing one’s understanding and interest in his/her profession.Go to:UNDERSTANDING WORDSWe go through life calling our colleagues by attaching the word ‘doctor’ before their names.‘Good morning Doctor James.’‘How do you do Doctor Polish?’What is intriguing is that despite using the word ‘doctor’ on a regular basis, not many people know what the word literally means in a medical context. I was well into in my final year of medical school when I came across its literal meaning.Now the question beckons, how many of us know or have tried to find out what the word ‘doctor’ means? A classic example of how we take the nuts and bolts of our profession for granted. ‘Doctor’ actually means ‘teacher or scholar’ (1), thus in the sentence ‘Doctor of Medicine.’ Other such words include the word ‘surgeon’ which interestingly enough means ‘handyman or manual labourer’ (1). Another example is that of the prefix ‘Rx’ while writing prescriptions. We tend to overlook that ‘Rx’ actually means recipe. Even more fascinating is when we realize that Rx is derived from the astrological sign for Jupiter, which was once placed on prescriptions to invoke that God’s blessing on the drug to help the patient recover. In a similar manner we tend to overlook the meaning of words like ‘physician,’ ‘medic’ and ‘nurse’ to quote a few examples.Go to:THE WHITE COATDuring medical school, like most other students, I also wore the white doctor’s overall with great pride. Surprisingly, yet again not many bother to question the objective or the white colour of the coat. And this naïve mind set is what actually concerns me.Interestingly enough, earlier in the history of medicine, the white overall was not white at all. It was black for quite a while (2). But after realizing that black conveyed a sense of mourning and approaching death, the color was changed to beige and then finally white. The color white representing purity, is a visual reminder of the physician’s commitment to do no harm. It communicates the physician’s medical intent and serves as a symbolic barrier (boundary perhaps?) that maintains the professional distance between physician and patient (2). The white coat reminds physicians of their professional duties, as prescribed by Hippocrates, to lead their lives and practice their art in uprightness and honour (2). Perhaps most importantly, the white coat is a cloak of compassion (3). Other reasons include professionalism, identification, and hygiene, yet white coats may also be a source of, rather than a barrier to, cross infection (4).It is intriguing how we wear the white coat regularly but almost never stop to think of its purpose or the reason for its colour. In a recent study conducted at Christchurch Hospital, New Zealand, patients were asked what they preferred their doctors to be wearing. Patients preferred doctors to wear semiformal attire, but the addition of a smiling face was even better. The next most preferred styles were semiformal without a smile, followed by white coat, formal suit, jeans, and casual dress (5).Go to:THE INSIGNIA OF MEDICINEA similar trend exists on assessing the awareness of the insignia of medicine and the wisdom behind it. Almost every medical practitioner has seen the symbol, may it be on white overalls, books, pens, conference posters, web pages, or identification cards. Yet it seems not many people know what the symbol stands for.The symbol of our profession is the ‘Aesculapius’ or the ‘Caduceus’ (Figure 2 and ​3). Either way it involves a single or two serpents (snakes) entwined around a single staff respectively (6). It really does seem a paradox how such a horrific insignia involving snakes could represent a profession dedicated to selfless patient care. One does not just wake up one day and say ‘lets’ make a snake around a staff and declare it our official insignia.’The AesculapiusIn Greek mythology, the Rod of Asclepius (Greek: Ράβδος του Ασκληπιού Rávdos tou Asklipioú; Unicode symbol: ⚕), also known as the Staff of Asclepius is a serpent-entwined rod wielded by the Greek god Asclepius, a deity associated with healing and medicine. The symbol has continued to be used in modern times, where it is associated with medicine and health care, yet frequently confused with the staff of the god Hermes, the caduceus. Theories have been proposed about the Greek origin of the symbol and its implications.Hippocrates (the father of medicine). Engraving by Peter Paul Rubens, 1638. Courtesy of the National Library of Medicine.Greek mythology reveals some amazing facts in this regard. It reveals that the ‘Caduceus’ is actually a representation of the Greek God of Commerce hence has been wrongly used all along. In reality, the logo of medicine is the Staff of Aesculapius, i.e. a single staff symbolizing the tree of life from the Garden of Eden entwined by a single serpent representing the vital forces of life, rejuvenation, wisdom and longevity. So the insignia is supposed to be a single serpent contradictory to the two serpent depiction regardless of asymmetry.It is very interesting to note that the Staff of Aesculapius (with the single serpent) actually gained recognition in the treatment of Dracunculus medinens is also known as guinea worm. This worm would crawl under the skin of the patient and the only way to remove the worm was to slit the skin and slowly wind the worm out around a stick. As this infection was common in those days, physicians advertised this service as a serpent or worm wrapped around a stick. Furthermore this procedure required know how, patience, close attention and a delicate touch, which made it a fitting symbol of a physician’s care (7).Go to:HISTORY OF MEDICINEHistory has long played a role in the education of physicians, but the uses of medicine’s past have changed over time. In the late nineteenth century, some physicians taught medical history to their students to supply a sense of continuity with professional traditions in times of rapid and bewildering change. Other physicians believed that instruction in medical history would impart a sense of refinement to medical practitioners (8). Nowadays, unfortunately the general perception is to concentrate on the science of medicine and take the humanities for granted.I believe that each practitioner should be aware of the history of the medicine he practices. To explain this further, let us take the example of the ‘percussion.’ With the help of percussion we determined the presence of various pathologies in the chest and abdomen by listening for the various types of notes but we seldom stop to question how Auenbrugger got the idea of striking a pleximeter placed on the human body to determine the presence of disease. Interestingly, he actually attributed his discovery to his boyhood experience watching his father tapping to define the level of fluid in kegs. He noticed the way beer brewers tapped the sides of the beer barrels to hear if they were full or empty. Applying the same principle, he was able to detect the presence of fluid in chest and abdomen (9).By knowing things like these, not only are we exposed to a lighter side of medicine but it also enables us to think like scientists. It makes us realize how in the past people noted an effect and transformed it into a useful substance or method. Apart from this by familiarizing oneself with history, we also pay homage to the ancestors of our profession. It is noteworthy how we take such things for granted just as if they appeared out of nowhere, hence denying our professional ancestors of the credit they deserve for deducing diagnostic methodology and treatments we use so regularly.Similarly, what about auscultation? Laennec did not just find an assembled stethoscope lying under a tree and said ‘Hey! What the heck! Let us just listen in for a diastolic murmur.’ Actually Laennec recognized how one can hear a pin scraping one end of a plank by putting one’s ear to the other end and as a result came up with the idea for a stethoscope prototype. He rolled a stack of paper into a cylinder, pressed one end to the patient’s chest, and held his ear to the other end. And so began auscultation (9).Apart from this, other examples of ignorance on our part include the ‘Hippocratic Oath.’ We all took the oath but never really bothered to find out who Hippocrates was (Figure 3).Go to:CAUGHT OFFSIDEOn the very first day of my clinical rotation our medical officer cried out: ‘Always examine the patient from the right side’. I asked him why it was so. Unsurprisingly, ‘traditions’ he remarked. I have always found this mind set of accepting things as they are without any sound reasoning bizarre. Traditions are always based on some reasoning. Still we choose not to bother ourselves to look for the reasoning and take the easier way out, which is ignoring to question them at all.Some people say we stand on the right as ‘it gives the doctor more manoeuvrability to examine with his right hand’ (10). Then, my question is: why do left-handed people stand on the right side as well? Or has the medical profession got something against the left-handed population now? The answer to why we always have to stand on the right side of the patient while examining him still evades me.Go to:SO WHAT’S THE POINT?By ignoring aspects like the ones stated above we deprive ourselves of the opportunity to understand our own identity and past as medical practitioners. Such aspects also present themselves as a lighter side of medicine which is dispossessed due to an unfortunate mind set of taking things for granted.The point is that the complete understanding of one’s profession is imperative to groom a well rounded professional. Clearly, in case of medicine, practitioners have a tendency to avoid the humanitie, and as a result have little background knowledge about the origins and traditions of our great profession. Thus limiting the magnetism of our career. Why is it that we do not question our traditions, origins and methodology? Are we scared or are we just not bothered? The white coat, the insignia, examining patient from the right, and the tendency to avoid our history are just a handful of examples. The understanding of medical humanities provides doctors with an opportunity to view the practice of medicine at a time when things like X-rays, CBCs and MRIs were not present. It provides inspiration to doctors as well help them understand the nature of our shared humanity (11).Doctors are generally experts in the art of delayed gratification and self-neglect (12) and bad at avoiding burnout (13). The understanding and study of medical traditions can play a role of a stress reliever and provide the practitioner with a more mature outlook. After all, broad range of interests and an encompassing world-view make for emotional and physical wellbeing (14).To achieve such an effect, such aspects of medicine should be incorporated within the medical curriculum at both undergraduate and postgraduate levels. Dispensing of such education will help medical students understand the scientific and humanistic character of medicine.The CaduceusGo to:REFERENCES1. Webster’s New World™ Medical Dictionary. 2nd Ed. Wiley Publishing, 2003.2. Jones VA. The White Coat: Why not follow suit? JAMA. 1999;281:478. [PubMed]3. Lewis LD. White Coat Ceremony Keynote Address. Presented at: Columbia University College of Physicians and Surgeons; August 26, 1994; New York, NY.4. Wong D, Nye K, Hollis P. Microbial Flora on Doctors’ White Coats. BMJ. 1991;303:1602–4.[PMC free article] [PubMed]5. Lill MM, Wilkinson TJ. Judging a Book by Its cover: Descriptive survey of patients’ preferences for doctors’ appearance and mode of dress. BMJ. 2005;331:1524–1527. [PMC free article] [PubMed]6. Wilcox RA, Whitham EM. The Symbol of Modern Medicine: Why one snake is more than two. Ann Intern Med. 2003;138:673–677. [PubMed]7. Potter, Edwin S. Serpents in Symbolism, Art, and Medicine: the Babylonian caduceus and Aesculapius club. Private printing: California 1937.8. Lederer SE, More SE, Howell JD. Medical history in the undergraduate medical curriculum. Acad Med. 1995;70(9):770–6. [PubMed]9. Angliss S. The Science Museum Book of Amazing Facts: Medicine. Hodder Books: London 1998.10. Fiona. History and Physical. Adventures in Medical School. http://www.urbanhonking.com/medschool/archives/2006/02/the_history_and.html 2006.11. Gaita R. A Common Humanity: Thinking about love and truth and justice. London: Routledge, 2000.12. Shadbolt N. Attitudes to Healthcare and Self-care Among Junior Medical officers: A preliminary report. Med J Aust. 2002;177 (1 Suppl):S19–S20. [PubMed]13. Schattner P, Davidson S, Serry N. Doctors’ Health and Wellbeing: Taking up the challenge in Australia. Med J Aust. 2004;181:348–349. [PubMed]14. Epstein R. Mindful Practice. JAMA. 1999;282:833–839. [PubMed]Old-school Skills vs. New Technologieshketsun, MD, Emergency Medicine, 10:13PM Jul 19, 20105th Year Medical Student, The Chinese University of Hong KongWhat would happen if I stood on the left side of a patient while auscultating the patient's heart?If I examine a patient on the left side in front of a doctor from Hong Kong, I would probably get this response: What are you doing? Is that the proper way to examine a patient?but I am not in Hong Kong right now, I am doing an away elective in Boston. Interestingly, the resident I was shadowing on the first night chose to stand on the left side of the patient to ausculate the patient's heart. I was very surprised because she is the first person that prefers to auscultate the heart from the left side.It is one of the central dogmas of physical examination (at least how I was taught) that you should always stand on the right side of the patient when possible. If you ask my professors why one must stand on the right side but not the left side, they would probably justify it in twenty different ways and telling you that it makes examination easier and more effective especially when you are right-handed. But the truth is that this is one of those conventions that has been passed on by generations of doctors. I did not get to ask the resident why she did that but obviously standing on the right side of a patient is not a central dogma to her.In Hong Kong and I assume in countries such as Australia, Britain, India, Malaysia and Singapore which follows the British-style medical training, physical examination and the interpretation of physical signs is highly emphasized. We are always taught to follow certain strict sequences in which our physical examination has to proceed. When I began my clinical years, I felt like I was learning how to dance. I have to learn the nuances of each step of the physical examination, for example the patient's hand must be well above the shoulder and my palm must be in contact with anterior surface but not posterior surface of the area slightly below the wrist when eliciting bounding pulse for aortic regurgitation.Senior doctors pays much attention in training medical students, correcting our techniques so that we become doctors who can perform elegant clinical examinations, inteprete clinical signs and formulate differential diagnoses without the help of modern investigations. Being able to perform physical examination in the "right" way and interpret signs accurately is central to the identity of a doctor and excellence in examination skills is central to being a good doctor even in the age of CT and MRI.In contrast, my impressions of the way medicine is practiced in the US is that that there is a greater reliance on technology and laborotory tests than on the "old-school" clinical examinations and interpretation of clinical signs. I was in a teaching round by a renowned professor in neurology with other residents here in Boston. While the professor was placing the bell of his stethoscope on the patient's closed eye in search for an audible bruit, I could tell that the residents were not particularly impressed, whereas when one of our professors demonstrated this technique to us in Hong Kong, my group was really excited to learn this technique. I talked to a resident who was trained in Australia for his medical degree but doing his residency here about my impressions on this. He shares similar feelings that physicians here rely more on imaging and laboratory tests and place less emphasis in physical examination to aid their diagnosis and managment of patients. There is also a much greater emphasis on research and the scientific aspect of medicine here in the US.It is true that physical examination plays a less important role in a time when CT and MRI are readily available. And no matter where you are trained, the new generation of doctors tend to view the traditional clinical method as less important. But does disregarding the importance of the traditional clinical method make us lose that human touch in medicine? Or does an over-emphasis of the traditional clinical method signify the fear and reluctance to embrace new technological advances in medicine?Why should the doctor stand on patient’s right side, when examining?Best Answer: Because most people are right handed, and examining with the right hand from the right side means that we face the patient. This is important for a few reasons, not least because you need to see the patients face to look for signs of pain etcMattTo the left, to the left.Posted on February 13, 2012“That was an excellent physical examination, Action Potential. Strong work.”“Thank you, sir.”“Of course, if you were a med student from my med school, I’d have to fail you.”“…erm?”“D’you know why?”“… I… nope.”“You did the entire examination from the left side of the patient.”“….”“We don’t do that.”“… We don’t?”“Of course not. It’s a tradition in medicine to stand on the patient’s right.”I felt a little blind-sided by this conversation, but I chalked it up to my preceptor’s med school just being weird (and also possibly a totalitarian dystopia where people are failed for standing wrong) – at least, until I remembered an encounter I once had with my family physician.Years ago, on an exceptionally busy day, her nurse had me wait in a different provider’s exam room. So my doctor walked in, started to greet me – then stopped mid-sentence and physically rearranged the damn furniture so she would have room to examine me from the right side.She had me hop off the exam table so she could pull the table away from the wall and everything.At the time I thought she was crazy, but now I’m realizing that it’s more likely that it’s Medicine as a field that’s crazy and in dire need of loosening up a bit but DING DING command “LoosenUp.exe” not recognized by server:medicine.Maybe I’m paranoid, but I’m beginning to suspect that it’s actually my school that’s weird for not requiring students to learn the physical exam exclusively from one singular, easily obstructed position with no versatility whatsoever.Do you examine patients only from the right? Did your med school tell you that’s the tradition? Does your med school care about this tradition to the point where they’d actually make it a policy? Do you want to fight?

I'm a 4th year student. At my university, there is no such “training” given to deal with nudity. At the beginning of year 1 I quite remember a teacher telling us to approach certain situations with professionalism and maturity, and that's that.Having said that, a doctor will not be in a situation where healthy people will be required to strip naked in front of them (well, unless you're a plastic surgeon, but still…) You will see someone's breast(s) or private parts only if a patient exposes it to you - for example if they have a rash in the area. So when you look at all these parts you are usually focusing on the matter at hand.At med school we are constantly exposed to case studies, patients, etc. Day 1 of med school if the teacher says “a patient comes in complaining of explosive diarrhea” some students might giggle a bit. By the end of the week, you've heard it often enough that you focus on possible diagnosis before anything else.Having said that, doctors and nurses are humans. Once in a while they will see something that might be amusing. For instance, I remember during my first year, Anatomy lab we surrounded a corpse and the teacher was briefing us about the different parts that we would be studying that semester. It was a male corpse that had already been cut up and cleaned, his skin removed (so that we could have a better glimpse of muscles and organs). The only “skin” part still attached to this male corpse was his private part - and it was quite impressive in size. It's not one of those things nobody would have noticed. So times like these you would have to display maturity, even if the only thing that comes to mind is “wowzer!”A friend of mine who works the night shift at the emergency room has also shared a lot of funny stories with me. You can imagine - things like 4am in the morning a 70 year old woman rushed to the hospital with torn privates because she was doing the dirty without lubrication. Obviously the ethics card would be to not reveal the person's name or any more intimate details about the patient to protect their identity. But yes, funny cases are still funny no matter which field of work you are in.On a more serious note, my grandmother died of cervical cancer. She had surgery and everything went downhill from there. After surgery she lost the ability to control her sphincters so she was using both catheter and adult diapers. She was bedridden and there were always nurses and my mother at her side, cleaning her and bathing her. It was not a pretty sight, there was always a stench. After her death, I remember my mother saying “I don't want to die like that. You lose your dignity when people have to wipe and clean you and you have to put diapers like a baby.” I was still a child at the time and I didn't understand what she meant.Doctors and nurses will tend to focus on cleaning the patient so that they will feel comfortable, and also to prevent further infection and complications. When they're all clean, you move on to the next patient. The patient does not lose any dignity in our eyes. After all, WE are all patients too.Don't ever worry about coming in and getting checked for anything you feel is out of the ordinary just because you feel shy or ashamed of exposing yourself to a medical professional. The objective is to get you all fixed up and happy!I would like to add: I have read some answers and some have mentioned studying ethics. The medical ethics course at my school primarily focuses on bigger issues such as euthanasia - a very real and ongoing debate, as well as patients and doctors rights, and so on.In every field there are bad eggs. If you ever feel sexually harassed by a medical professional, first ask a 2nd or even 3rd doctor if the procedure or exposure you experienced was necessary for the checkup you requested. It is necessary to report sexual harassment.When I was a 18 I had to do a physical examination for my driving license (in my country you cannot drive before you turn 18). The male doctor (I am female) was waiting for me at his office and did basic things like checking my weight, my vision, and so on. Nothing out of the ordinary.Then he got up, locked the door and told me to remove my top and bra, and proceeded to give me a “breast exam.” It sounds quite funny because there is no serious way to give a more serious account of that situation but if the person being checked had been my daughter I would make sure the doctor loses his license and spends a few years behind bars. I was young and didn't understand what was necessary and what wasn’t. A medical worker who violates one patient probably violates as many as they can get away with. They abuse their position and should not be in this field.