Like most physicians, I really feel extraordinarily rushed in the course of the course of my work day. And daily I’m tempted to chop corners to get my documentation accomplished. The “in the event you didn’t doc it, it didn’t occur” mantra has been crushed into us, and we now have turn into enslaved to the quantitative. It’s tempting to hurry via bodily exams, assuming that if there’s something “actually dangerous” happening with the affected person, some lab check or imaging research will ultimately uncover it. Simply swoop in, take heed to the anterior chest wall, ask if there’s any new ache, and sprint off to the subsequent hospital mattress. Then we assemble a 5-web page progress notice within the EMR, describing the encounter, our evaluation, and plan of care.

Targeted bodily exams have their place in comply with up care, however I strongly urge us all to rethink skimping on our exams. A superb-toothed comb must be utilized in any first-time assembly – as a result of a lot might be missed as we scurry about. Some examples of issues I found throughout cautious examination:

1. A pulsatile stomach mass in a lady being labored up for dizziness.

2. New slurred speech in an edentulous gentleman with poorly managed hypertension.

three. A stump abscess in a 2-yr-previous leg amputation.

four. A bullet lodged within the scrotum.

5. Numerous stage 1 sacral decubitus and heel ulcers.

6. Melanoma.

7. Rashes that have been bothering the affected person for years however had not beforehand been addressed and cured.

eight. Early cellulitis from IV website.

9. Deep venous thrombosis of the calf.

10. New onset atrial fibrillation.

eleven. Thrush.

12. Cataracts.

thirteen. Peripheral neuropathies of varied sorts.

14. Lateral medullary syndrome.

15. Surgical scars of all stripes – indicating earlier pathology and lacking organs of various significance.

sixteen. Regular strain hydrocephalus in a affected person who had been operated on for spinal stenosis/scoliosis.

17. Parkinson’s Illness in a affected person with a fractured hip.

18. Shingles in an individual with eye ache.

19. Aortic stenosis in a lady with dizziness.

20. Pleural effusions in a person complaining of hysteria.

Oftentimes I don’t discover something new and thrilling that isn’t already part of the affected person’s medical report. However a curious factor occurred to me the opposite day that made me mirror on the significance of the bodily examination. After a cautious evaluate of a posh affected person’s historical past, I mentioned each scar and “abnormality” I found as I did a radical head-to-toe assessment of his bodily presentation. His ageing physique revealed greater than he had remembered to say… and as our examination drew to an in depth, he reached out and provided me a fist-bump.

It was charming and sudden – however made me understand the true significance of the thorough examination. I had gotten to know him within the course of, I had earned his belief, and we had constructed the type of therapeutic relationship upon which good healthcare is predicated. No EMR documentation effort was value lacking out on this interplay.

Chances are you’ll not uncover a brand new analysis on every bodily examination, however you possibly can achieve one thing simply as essential. The arrogance and respect of the affected person.



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