Skip to main content

How not to do a physical exam

Yesterday I had APD and was with my classmate/partner and our instructor Dr. Phillips. He introduced us to a woman in the VA who had severe right lower abdominal pain who was admitted Thursday. She was on a morphine drip, and reported that the pain was so terrible she was passing out when she was admitted. Since APD is essentially a class on doing patient histories and physical exams, this was "practice" for us. We spent a good hour asking every question we could, exhausting our minds for medically relevant topics, and only then did a complete physical exam (almost a complete physical).

By the time we reached the physical exam, Dr. Phillips had left to go to the swamp (the residents' workstation room) and said he'd wait for us. As my classmate and I moved through the physical, we reached the abdomen. I gently examined the lady's abdomen, noting that she flinched and guarded when I began to press firmly. I moved back and Blair repeated, with questions in between. As Blair asked the woman a question, I was running in my mind the steps of the physical exam, and realized I needed to determine the woman's liver size. You determine this by lightly tapping the abdomen and listening for the difference in resonance. Something that didn't cross my mind was that this woman was in the hospital with severe abdominal pain, and as soon as i made my first tap (which she was not expecting) she grimaced and groaned in pain, doubling up on her bed.

The moral of the story is, don't do anything on a physical that you haven't informed/warned the patient you are about to do.

Popular posts from this blog

The $2000 monkey on my back, deferred

It’s been more than a week, and I think an update is due. Plus, I can give updates on my own status with my heart murmur, having seen the doctor this past Friday. The only thing that has kept me from updating until now is simply laziness (in other words, I was far too busy studying/eating/cleaning/sleeping to actually relax and write). This past Friday I went to the Student Health Center to see my doctor about the previously mentioned murmur recently discovered. My doctor presumed it was most likely an innocent flow murmur, which occurs if a heart valve doesn’t close all the way or in time when the heart beats, allowing blood to flow back the opposite way, and the blood causes turbulence heard as noise. If you’ve ever heard turbulent water flowing over and through rocks and back upstream in eddies in a river, you should get the idea of what a murmur is. It was recommended that I have an echocardiography done, or an ultrasound picture of my heart. This would allow us to see exactly how ...
Read more

My First Week: 2 South psych ward

Monday last week was orientation for clinical rotation on the psychiatry ward. It was exciting and intimidating all at the same time, especially the part about getting security keys, fingerprinted, and having to provide a urine sample for drug screening. It was a calm day regardless though, and there was no work with actual patients until Tuesday. Tuesday morning I made my way through the string of locked doors at Mid-Missouri Mental Health Center (hereout referred to as Mid-MO), the mental health hospital. I am assigned to the ward on 2 south. I met the psych resident assigned to the floor, Dr. Johnson (not his real name of course), and discovered I and the other two medical students assigned to the floor would accompany him to the county courthouse to start the day. Dr. Johnson had to take the stand to testify to the need for inpatient treatment for a number of mentally ill individuals who were picked up by the law. It was an interesting start to the day. After court hearings we hurr...
Read more

School, Shaving, Serpentine Belts, and Sex

It's been all about the S the last few days. On Saturday (ironic, it starts with an 'S' day), my battery in my Jeep completely died a sudden death. There was a plastic sleeve attached to the battery that contained the purchase receipt. Purchased in 2002, well that explains it. It took about 10 - 15 phone calls to actually find someone available to take me to O'Reily's (I was trying to work out in concentric circles from my house), but I finally got a new battery. The guy testing the old one simply said, "Yup, it's dead," with a total resignation telling me that there was no hope in rejuvenating it. New battery, check. Now I'm mobile again... Fast forward to where I'm headed west on Stadium. A loud thunk followed by an instantaneous loss of power steering control, coupled with a drop in battery voltage from 14 V to barely 10 V, and a slowly rising engine thermometer told me something was wrong with the Jeep. I drove to HyVee's parking lot, p...
Read more