Intern Skills - General Physical Exam

This past week was spent finishing and polishing my presentation for Grand Rounds titled "Safely managing prehypertension and stage 1 hypertension with botanicals." This is a subject that is close to my heart if you will since hypertension and strokes are a common occurrence on my father's side of the family.

Hypertension has been called the "silent killer" as a patient may not notice any symptoms until a significant medical event such as a stroke or heart attack occurs. A skilled, thorough doctor performing a routine general physical exam can sometimes uncover masked symptoms, which a patient may not even be cognizant about. A well-performed physical exam can help prevent illness or even prevent an early death.

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At NUHS, we are trained on basic physical exam skills beginning in our second of 10 trimesters. We are taught to fully examine the patient through observation, listening, touch, and measurement. As we progress through the curriculum, we build upon our basic skillset and learn to interpret what we discover. This interpretation is honed under the guidance of our clinicians in the Whole Health Center and satellite offices.

A quick rundown of some of our exam procedures includes:

  • Observing the patient, their demeanor, alertness and responsiveness
  • Observing the patient's skin for hydration, trauma, lesions, or color
  • Measuring height, weight and visual acuity both near and far
  • Taking vital signs: temp, heart rate, breathing rate and blood pressure
  • Examining the head and neck, including lymph nodes and thyroid
  • Testing all cranial nerves
  • Checking the internal components of the eye, as well as the lens and cornea
  • Checking the ear, sinuses, nose, mouth, and throat
  • Listening to the patient's lungs and heart thoroughly
  • Testing muscle strength in the patient's arms, legs, hands, and feet
  • Testing muscle reflexes in both arms and legs on each side
  • Testing patient's sense of joint awareness and planned movements
  • Performing a full abdominal exam, listening for bowel sounds (good)
  • Measuring the size of the liver and spleen through tapping and listening for a change in sound
  • Listening for any abnormal sounds in any major arteries of the body

This seems like a lot to do in one visit, especially if the patient is in a hurry. We have the physical exam presented so often, that by the time we are in clinic, we can perform this exam in 30 minutes or less! This gives plenty of time for the remainder of the patient visit and conversation. The general physical exam is intended as a screening tool to determine if more focused examinations are required for the patient. The physical exam skillset we learn at NUHS helps us to target key systems with quick, accurate examinations. When in practice as primary care doctors, we will rely on this skillset each day with our future patients. These skills will help us save lives.