Working with several outpatient providers now in our “chronic and preventive care” rotation block, which includes outpatient family medicine, internal medicine, neurology, and psychiatry, I feel that my physical exam skills have become much more refined, thanks to the advice of my preceptors. They have taught me how to be more efficient, less awkward in my flow, and more comprehensive. Here are some of the pointers I found most helpful that I wanted to share because I feel it will be beneficial for anyone going into any field to know:
- To create a smoother flow, think about the tools you are going to use. If you know you are going to use the otoscope to look in the ears, consider looking in the mouth next, and then the nose. This way, you won’t have to transition to putting back the otoscope, and then scrambling to grab it again when you need it. Minimizing awkward transitions is important to looking like you know what you are doing.
- Along the same lines as above, having the patient lay back while performing the cardiovascular exam helps minimize transitions in the exam – you can listen to their lungs, have them lie back and listen to their heart, and then move your stethoscope to their abdomen to listen for bowel sounds. This way, you aren’t pulling out your stethoscope every few moments to listen to different organ systems!
- Asking pertinent ROS questions as you are examining the specific organ system – I have found this to be monumentally helpful/efficient as you do not have to spend time asking these questions during history taking, and it makes the exam less eerie and fills the silence!