The first half hour of clinic shifts starts with preview. Every day in preview is different. Sometimes we talk about various lab tests, discuss difficult cases, or learn about therapies we didn’t cover in class.
Last week in preview, Michelle Ennsmann, DC, ND, showed us 8th tri interns how she does a head-to-toe physical exam in under 20 minutes. We already know how to do physical exams, but it usually takes us a lot longer than that. To accomplish a speedy yet thorough exam, there are three key points that I gathered from her demonstration:
- supplies out and ready;
- patient instructions and positioning;
- go in order.
Dr. Ennsmann said that in her private practice, she lays out all of her medical instruments and other supplies that she’ll need in advance. Having a countertop to put things on so that you’re ready for every part of the physical exam is essential. In the NUHS Clinic, we don’t have the luxury of leaving our equipment in exam rooms because all of the rooms are shared spaces; however, we can go to two of the larger rooms and set things up in advance.
It’s important for patients to know what to expect, because most physicians don’t do head-to-toe physical exams, rather, complaint-focused exams. Explaining all pieces of the exam (listening to lungs, heart, neuro exam, checking muscles, etc.) will keep things flowing so that you don’t have to stop and explain something in the middle of the procedure.
Developing a pattern with a rhythm to it takes time, but once that happens, the head-to-toe physical exam will become second nature. Stopping to think about what is next after each portion is a huge time-saver. Consistency and repetition are key.
I am striving to implement these key points so that I can become more efficient with physical exams!