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Archive for April 2nd, 2008

Importance of Physical Exam

Posted by medliorator on April 2, 2008

A telling vignette from ValJones @ Dr. Val and The Voice of Reason:

One intern presented a case of a patient with “fever of unknown origin” (FUO). This particular diagnosis will make any internal medicine specialist delirious with curiosity and excitement, since it means that all the previous attempts at discerning the cause of the patients fever have failed. Generally, a fever only receives this exciting honor when it has gone on for at least 3 weeks without apparent cause.


The intern explained… every single potential cause of the fever and how he had ruled them out with tests and deductive reasoning. The attending was hanging on every word, and nodding in approval of some real zebras (rare and highly unlikely causes for the fever) that the intern had thought to consider and disprove.


I must admit that my mind wandered a bit during this long exercise, and instead I looked at the patient, smiled, and examined his thick frame with my eyes. Of course, an attending has a keen sense for wandering minds, and so to “teach me a lesson” he abruptly stopped the intern’s presentation and looked me dead in the eye. You could have heard a pin drop.


“So, Dr. Jones” he snarled. “You seem to have this all sorted out, don’t you. Apparently you have determined the diagnosis?”

“Well, yes, I think I may have.” I replied calmly.


The attending’s face turned a slightly brighter pink. “Well, then, don’t withhold your brilliance from us any longer. You’re a rehab resident, are you not?” He made a dismissive move with his right hand and rolled his eyes.


“Yes, I am.” (Snickers from the internal medicine residents.) I shot a glance at them that shut them up.


I continued, “Well, Dr. ‘Attending,’ as the intern was reviewing the potential causes of FUO, I took a look at the patient. It seems that there is a pus stain on the bottom of his right sock. I didn’t hear the intern describe the patient’s foot exam.”


The intern’s face went white as a sheet.


The attending turned to the intern with an expression of betrayal. “Did you examine this patient’s feet?”


“Well I uh… well, no.” Stammered the intern. “I guess I forgot to remove his socks.”


The attending marched over to the bedside and quickly removed the patient’s right sock, a small snow storm of dried skin flakes fell gently to the hospital floor. A festering foot ulcer proudly displayed itself to the team.

The Physical Exam Can Be Pretty Important, Part 2 [RevolutionHealth]

Posted in Clinical Rotations, Diagnostic Examination, Internal Medicine | Comments Off on Importance of Physical Exam