Health

10 Tips On How To Be An Effective Intern: The Physical Exam

A list of 10 clinical pearls about the physical exam that will help you be a more effective intern, and deliver better patient care.

I know that some of these (e.g. tailor your exam to why the patient is in the hospital, don’t shortchange exams on patients with disabilities) seem obvious, but I see these concepts forgotten or ignored all of the time. If I had a dime for every progress note whose exam was verbatim: “Chest – CTAB; Heart – RRR, nl S1 S2, no m/r/g; Abd – Soft, NT, ND, normal BS; Extremities – No c/c/e; Neuro – AAOx3, non-focal” irrespective of whether the patient was admitted for a stroke, arrhythmia, or bowel perforation…

A few references:

The lack of hypotension in the majority of patients with pericardial tamponade: https://jamanetwork.com/journals/jama/article-abstract/206803

The uselessness of auscultation of bowel sounds:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566372/

Listening to Bowel Sounds: An Outdated Practice?

Tips and exam strategies for patients with physical or cognitive disabilities:
https://wordpress.uchospitals.edu/transitioncare/files/2012/05/Kalichman.ExamStrategies.pdf
https://www.mountsinai.org/about/diversity/disabilities/physical-sensory-disabilities

A wonderful, general resource for learning more about the physical exam:
https://stanfordmedicine25.stanford.edu/

The video thumbnail incorporated a picture of a reflex hammer provided by user MacSeagull under CC BY SA 4.0 and downloaded from Wikimedia Commons July 2019.

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