The Doctor Exam

Who knew that saying "99" can be used to check for tactile fremitis?

And I never knew I could use the back of a reflex hammer to percuss the lung fields. Traditionally, percussion involves laying one finger on the the surface (like the abdomen or the back) and tapping that same finger using another finger. Depending on if there is air or a solid structure present, different sounds will be produced, some sound like a hollow echo, others a dull thud. It's kind of like what you do when you tap on a wall to find a place to hammer a nail.

Today we had another exam. This exam was a little different; it did not involve knowing facts and formulas and complex concepts. We were not sitting in a lecture hall. Instead, we were in a patient exam room. This test was unusual- it was the observed physical exam.

In 30-45 minutes we had to perform a complete (head to toe) physical on a patient in front of an observer. In this case, our patient was a fellow classmate and our oberserver was a fourth year medical student.

For the last seven weeks, we have worked in small physical groups, learning and mastering physical exam skills. We became famililar with the motions of how to do things such as percussing for the lungs and liver, palpating for the PMI, auscultating (listening to) the heart and lungs, assessing joint laxity using the Lachman test, and checking range of motion (among other things outlined on an extensive check list).

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Before our first physical exam class, we were told that we would be doing physicals on each other and that we should be prepared to disrobe in front of each other. The dress code was simple; the ladies were instructed to wear sports bras and patient gowns would be provided. Needless to say, physical exam practice sessions initially had their share of awkwardness.

It was funny trying to figure out all the motions on each other. I will never forget the cold hands, the poking, the eyes inspecting me, and those yoga mats we had to lay on. I did get a friend out of this class--Andrea my physical exam partner. We had our adventures discovering how to find things on each other and we laughed all the way there.

We have a joke between us. Andrea puts it nicely: "After taking this class, I'm only going to know how to do a physical on Eisha."

Andrea was my patient and I was Andrea's patient. And we both passed. Check!

We have come a far way from when we were given our white coats. When we started, we fumbled with our new shiny stethoscopes, struggled to percuss and palpate, and now we can perform a physical exam from head to toe. Ok, we have light-years to go. The next step will be to figure out what all these physical exam findings mean...

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Image: From my collection- "Hand on Hand."