To the left, to the left.

“That was an excellent physical examination, Action Potential.  Strong work.”
“Thank you, sir.”
“Of course, if you were a med student from my med school, I’d have to fail you.”
“D’you know why?”
“… I… nope.”
“You did the entire examination from the left side of the patient.”
“We don’t do that.”
“… We don’t?”
“Of course not. It’s a tradition in medicine to stand on the patient’s right.”

I felt a little blind-sided by this conversation, but I chalked it up to my preceptor’s med school just being weird (and also possibly a totalitarian dystopia where people are failed for standing wrong) – at least, until I remembered an encounter I once had with my family physician.

Years ago, on an exceptionally busy day, her nurse had me wait in a different provider’s exam room.  So my doctor walked in, started to greet me – then stopped mid-sentence and physically rearranged the damn furniture so she would have room to examine me from the right side.

She had me hop off the exam table so she could pull the table away from the wall and everything.

At the time I thought she was crazy, but now I’m realizing that it’s more likely that it’s Medicine as a field that’s crazy and in dire need of loosening up a bit but DING DING command “LoosenUp.exe” not recognized by server:medicine.

Maybe I’m paranoid, but I’m beginning to suspect that it’s actually my school that’s weird for not requiring students to learn the physical exam exclusively from one singular, easily obstructed position with no versatility whatsoever.

Do you examine patients only from the right?  Did your med school tell you that’s the tradition?  Does your med school care about this tradition to the point where they’d actually make it a policy?  Do you want to fight?

I’m kidding.  Of course you do.  We have a difference of opinion here, and – as a med student – I know of no other way to solve it.  (Besides maybe just having an extended passive-aggressive Letters to The Editor war about it in a major scientific journal.  Also an option!)

38 thoughts on “To the left, to the left.

  1. I can’t say we were taught that way. It seems quite silly really….level one trauma rolls in and the physician stops everything just so he/she can stand on the correct side of the patient? How many injuries have been missed on the left side of patient because a physician doesn’t stand on that side to get a full view?

  2. I’m with Solitary Diner. Maybe this is a Canadian (and therefore British colonial) thing?

    On a more serious note though, are you right handed? Because there are quite a few physical exam maneuvers that I think are more awkward if you’re right handed and examining from the left side. Case in point: have you ever tried doing a cervical exam from the patient’s left side? It’s extremely awkward.

    It may seem like a moot point now, if you’re doing the same movements over and over again over years, ergonomics are your friend.

  3. At my school in australia (which also supports Liana’s british colonial theory), we’re also taught to examine from the right… I don’t think they’d fail you if you didn’t but you might get marks taken off.

  4. I’ve been told off in front of patients for not palpating a guys abdomen from the right side. never mind he had an excruciating oozing wound that I would have squashed in the process. Total bullshit but yep, our school enforces it. I tried arguing, but this particular patronising pretentious douchebag had already taken a dislike to me for being female, short-haired and wearing pants. *eye roll*

    • i thought the rational behind palpating the abdomen (clockwise from LLQ, yes?) was to follow the course of the bowel? i mean, a reasonable exception should be made for avoiding a gaping wound, but my understanding was that at least this rule wasn’t entirely arbitrary.

      • I’m now MORE confused by your school’s explanation. Can’t you just palpate the abdomen clockwise from LLQ… from the left side? I feel like I’m missing something.

        (Although I usually palpate clockwise from the LRQ so I’m starting with the cecum/appendix and ending with the rectum, which would also be logical, I think.)

        • 1: i meant LRQ. whoops. hazard of being at an osteopathic school, you confuse your own left and right with the patient’s all-the-freaking-time. even the fingers-make-an-L-for-left trick doesn’t work any more, because in anatomical position, that happens on your *right* side…

          2: i think i mistook lau’s comment as regarding the direction of palpation, not the side to stand on (which is stupid, as that’s CLEARLY the discussion that everyone is having here). so, no excuse for that one either. =/

  5. Yep, always from the right!! I go to a US school that is not very tradition-bound, either. I thought that it was just standard in medicine to do it that way.

  6. In my office the rooms are all set up to examine from the left.
    Until 3 minutes ago I’d never even heard of such being an issue.
    I examine patients in the hospital from either side depending on where the bed is in relation to the wall and where other people/equipment are. It is a complete non-issue.

  7. I think it’s a British thing – I went to a very old-style London medical school where examining from the left was a cardinal sin. Bizarre, but there you go.

  8. My med school teaches us to examine from the right side and we get marks for it in OSCEs. I’m in the UK so perhaps it is a British thing to do, like auscultating for bowel sounds after palpating.

  9. My med school teaches us to examine from the right, we get marks for it in OSCEs. I’m in the UK so maybe it is a British thing, like auscultating for bowel sounds after palpating.

  10. I’ve literally never even heard of this before. We’ve been told to do as much as you can on one side of the patient to save time, and that it’s faster for you to hop over to the other side of the table than to make the patient move (yes, our doctoring instructor actually used the word ‘hop’), but that’s it. Clearly we’re rebels here at SIU SOM, just bucking tradition all over the place.

  11. I study in the UK and we were told just last week that if we stand on the left hand side of our patients during finals it is an immediate fail. Scary thoughts.

  12. they did tell us that examining from the patient’s right side is “the way it’s done,” with some kind of explanation like “there’s a subconscious psychological reaction to having someone stand on your non-dominant side, it’s intimidating, and since most people are right-handed, we stand on the right.” whatever — i’ll remember that and follow when i can, but i’m not going to rearrange furniture (?!?) to make it happen.

  13. Here in Portugal they do tell us to examine the patient at their right, and we do lose points at OSCEs if we don’t. Furniture is almost always arranged in a way that you can do so. However, in an ER, for example, sometimes we do examine the patient from the left.

  14. Im in PA school, if we start our physical exam on the left, they don’t let us continue.
    Its one of those things for some strange reason, step on a stool if you need to reach the spleen but still stand on the right always.

  15. hehe, there’s just too many protocols in medicine I think ! I’m a med student from Pakistan, we’re taught to stand on the right too and our marks get deducted in OSCEs for not doing that. As for the abdominal exam, we were told to ask the pt first if he/she has pain or tenderness any where in the abdomen, if yes then that area should be the last area to be palpated while moving in an S pattern through the quadrants. If there’s no pain/tenderness we start from the LLQ and move in an S pattern, some books and teachers follow the G pattern too though.

  16. I vaguely remember being told this ONCE on an OSCE, but never again.

    Then again, I rarely get any kind of adult supervision, so maybe I’m not the best person to ask.

  17. I don’t remember it ever being emphasized much at school, but I have one attending who insists on it. But most of our exam rooms are set up so that it’s more natural to go to the right side.

  18. It is emphasized at my school too, and everyone gets fidgety when they can’t stand on the Right of the patient. I have heard from some students that they once set up an OSCE with the only way to stand being on the left so that the student had to rearrange the furniture before examining the pt or fail that station! Craziness!!

  19. We are taught that too, in a non-fascist kind of way. The younger doctors always tell us, “If you get the very old Dr-so-and-so, be sure to stand on the right, or he WILL fail you.”
    Apparently, a lot of the examination techniques are just more difficult from the left. Which rings true if you are trying to palpate the liver, come to think of it…

  20. Just to add more evidence: at my medical school here in the UK we DEFINITELY ALWAYS 100% must examine from the right. It’s a failable offence here also to examine from the left. In fact, thinking about examining from the left gives me shivers of horror.

  21. Enforced at my medical school for OSCEs, but in hospital it depends. In Abdo surgery, for example, our registrar wouldn’t listen to your patient presentation if you hadn’t examined from the right. But in trauma, nobody cares.

  22. We were taught to examine from the right unless there was a good reason not to.
    No reason was offered, except, “It’s just done that way, we don’t know why, so do it that way unless it’s a problem.”
    A few years into practice, it feels quite wrong to me if I’m on the left. That said, if the patient is deaf on their right but hears me from the left, or there is furniture or family members in the way, I just examine from the left. It’s hardly worth fussing over.

  23. Same is the case with my professors……. EXAMINE THE ABDOMEN FROM THE RIGHT! NEVER THE LEFT!
    (And when you ask why….. most are plain speechless)….
    Maybe it’s cuz they’ve been doing it from the right side all their life as many books tend to prefer the right side over the left one, so the idea that one could attempt to examine the abdomen from the left probably seems absurd & somewhat…. unethical… them.
    I Opine that the right side would offer greater convenience to the right-handed docs. that’s all.

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