Today I gave my first physical exam

So naturally, I memorized the order of every procedure and test, which was apparently unnecessary and possibly a little weird.

Preceptor:  Alright – AP, you’re going first.
Me:  Okay.
Preceptor:  Wait, you need the order.  Where are your physical exam instructions?
Me: *points at head* … Here?
Preceptor:  YOU MEMORIZED IT?
Me: But weren’t we.. suppos- no?
Other Students: *expressions that say “No.  Also, we are defriending you.”*
Me:  … Ah.  Well then.

What can I say?  Apparently I just inferred “memorize this” from… well, I’m not sure what from.  Perhaps the fact that I was handed something which was memorize-able.

But seriously, whenever I’ve pictured myself as a doctor, I’ve always seen myself doing a physical exam.  If I’m not good at anything else in medicine – if I don’t know the answer to questions, if I suck at drawing blood or staying out of the way in surgery – I at least want to be phenomenal at the one thing I’ve always seen doctors doing.

So I guess the idea of going from “learning how to give a physical exam” (every session until today) to “actually giving physical exams” (today) set off some kind of That Girl Who Needlessly Memorizes Things trigger in me – because sure, when we were just learning it was fine to know nothing, but when I’m actually giving a physical, I feel like I should know everything in the history of ever.

And even though the physical itself went fine, I can’t believe how incredibly difficult it is to get all the details right – which sucks, because without the details, it all just feels like nervous fumbling and insecure posturing. There’s so much to keep in mind:

1.  What am I actually testing?
2.  How to do the actual test itself.  (i.e. Do not put your stethoscope on backwards.  It does not inspire confidence.)
3.  Hiding any uncertainty.
4.  Explaining everything to the patient.
5.  But without using any big words, or sounding like anything’s abnormal when in fact everything in the world is “Normal, completely normal.”
6.  Not stringing cords across the patient, dropping tuning forks on their knees, or, indeed ever standing directly in front of them.

This is another reason that I think our “Learn How To Talk To Patients As If They Were Real People!” class was useless.  Talking to patients isn’t the problem – the problem is talking to patients while trying to hold 10 clinical possibilities and 20 tests in your mind at the same time as simultaneously not dropping a $500 otoscope.

I know it only comes with time and practice.  But I really just wish that if, say, the first 100 physical exams anyone gives are destined to be awkward and mediocre – that I could just do the first 50 on the mirror and the last 50 on my boyfriend, and be perfect in front of every patient I will ever see.