Physical Examination

• The aim here is to teach you how to examine a patient in the examination room.

• Always wash your hands with soap before the physical examination.  So as not to lose time, while washing your hands, turn your head toward the patient and continue your conversation.

• Never examine through the gown.  Always keep the patient’s body covered or draped as much as possible. Expose only the part being examined.

• Don’t hesitate to examine the heart in a female patient. Leaving the bra on, ask her to lift her breast for PMI (Point of maximum impulse) and auscultation.

• It is permissible to place the stethoscope down between the breasts to continue listening. Don’t do a breast examination.

• The dictum is to inform the patient what you are doing during the examination.

Ex: Start like this:

You:  "Ok, Mr. Samson now I would like to do a physical examination on you. For that, I need to untie your gown. Is that ok with you?" 

SP: "Yes, it’s ok"

You: "Thank you"

• If the patient resists you, then you have to explain the importance of the examination to understand the disease process. Something like this:

You: "Mr. Samson, I can understand your feelings but to clearly understand the disease I have to do this examination. It won’t take more than a minute. Don’t worry. I’m here to assist you. I will tell you whatever I’m going to do."

• Some physical findings can be expressed on the SP’s face (faked). So, be careful and always observe SP’s face while examining him. Sometimes, you may get a SP with hypertrophic tonsils, as a case of a sore throat.

• Always do a focused, relevant examination. You won’t have time to do everything. Prioritizing will come only with repeated practice.

Respiratory Examination :

• Ideally, the patient should be sitting on the end of an exam table.

Inspection:

You: "Now, I would like to examine your chest. Is that OK with you?"

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