Lately, my total lack of clinical exam skills have me a little depressed. So I’ve been looking for a new clinical exam book – not the kind that tells me all the sanctioned Bates and Mosby “clinical pearls” I’ve already read – but some kind of real advice that’s actually going to make things smoother for me. Preferentially totally un-sanctioned and to be taken with a lot of skepticism – like the kind you’d get from pestering a beleaguered, possibly drunk, old physician for advice.
And this is that book. It’s amazing. It’s biased. It’s hilarious. I believe Amazon correctly bills it as “The Hitchhiker’s Guide To Medicine”. I bookmarked too many pages to know what I should quote for you, but here’s an example of what I’m talking about:
“Abdominal Examination: Auscultation of the abdomen usually takes patients by surprise, but has four principal functions: 1. It covers up the times you automatically reach for your stethoscope when about to undertake the unfamiliar task of examining the abdomen. Make sure that you do not re-lose credibility by asking the patient to breathe in and out through their mouth while you listen.”
And here’s a short quote (from what’s actually a really long section):
“Lung Auscultation Do have a quick listen at the lung bases for crackles. Do use this opportunity to check for sacral edema. As with ankles, don’t really press for 30 seconds. The guy who said that this demonstrates pathological edema has never worn socks.”
Okay, I can’t help myself. One more!
“Pulse: Take it over 15 seconds and multiply by four. Statistically speaking, you will get a more representative figure by counting over half an hour and dividing by 30, but this method is not advised.”
If nothing else, I suggest you go to the book’s Amazon page just so you can download the free sample. God knows I haven’t been given anything to post about it, but it’s already made my day about 10 times better. Or at least more entertaining.