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.

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8 thoughts on “Today I gave my first physical exam

  1. As a patient, I think i would be impressed to know you memorized the order, regardless of what that means about whether or not you’ll remember other important stuff.

  2. Hi AP…

    It was impressive that you memorized that. When I encounter new Nursing procedures for the first time, I also turn paranoid and memorize the steps (if I can) haha. Though I will never tell my friends because they will also defriend me if they find out 😉 But it is indeed different when you are already doing it for real.

    Anyway, good luck with that. Hope you have more exciting experiences coming up. Do continue to update us with your entertaining stories on your blog.

    From your loyal lurker haha (kidding).

  3. Perhaps you’ll have to memorize it for the exam? We had an ‘Physical exam exam’, in which we had to examine a classmate. During the practise sessions everyone was allowed to look at the instructions, during the exam we were supposed to know/do all the things you listed.
    Which can result in errors like mixing up tests (I HATE the drawer & pivot shift tests!) or wrongly naming structures (in Dutch, the word for the faucial pillars (pharynx bogen) is very similar to the English embryological pharyngeal arches (kieuw bogen, gill arches) so I essentially said on the exam that my classmate had gills.).

    So… don’t feel bad for memorizing 🙂 You’ll remember it better this way, it’s much better than having to cram everything last-minute.

    *yes I needed to look up the word for faucial pillars. Pharyngeal arches is much easier 😛

  4. I’d say its less important to know EVERYTHING ABOUT EVERY TEST EVAR!!!!11! but rather get comfortable doing the test, so it becomes second nature to you. Once you’re finished the test, you can put it all together at the end (once you get a chance to think about it). The pre-clerkship years should be about filling the toolbox; the clerkship years are about actually figuring out which tools to use when.

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