This week we bring you a great resource to help you learn physical examination skills.
Medical and PA students are taught that 95% of any diagnosis comes from the history (interview) with the patient, meaning that you should usually have a pretty good idea of what is going on with a patient before you ever lay a hand on them. But today’s resource is about the other 5%. The technique.
There is a growing chorus of medical professionals who believe that things like CAT scans, blood tests, and specialist consults have pushed that very important 5% — the physical examination technique itself– out of the picture. The result, they say, is that the art of physical diagnosis is slowly being lost.
The Stanford 25 is a list of 25 skills that every clinician should learn and master. The list was compiled by a team of doctors at Stanford University School of Medicine who noticed that in the latter two years of medical school, students know plenty of theory, but not much technique. The website was constructed so that the 25 skills that the team chose could more easily be mastered. But the skills aren’t easy, or they wouldn’t need a website for them. So as you check out the 25, consider your goal in using the site:
- If you’re totally green in medicine, check it out to get a glimpse of the fun stuff you’ll be learning as a PA student, and doing as a PA.
- If you work in the medical field, but don’t yet know much about doing physical exams, use the 25 to develop good habits from the start of your work with patients.
- If you’re a PA or medical student already, the 25 is a great way to close the gaps in your knowledge.
- Examine the back of the eye
- Examine the pupil of the eye and its response to light
- Examine the thyroid gland
- Examine the neck veins for abnormal size and pulses
- Examine the lung’s surface, lung sounds and borders
- Evaluate the heart’s motion
- Examine the liver’s size and shape
- Evaluate the spleen’s size and density
- Evaluate gait (walking movements)
- Test ankle reflexes for nerve abnormalities
- Identify markers of liver disease throughout the body
- Identify signs of stroke caused by blockage of a deep brain artery
- Examine the knee
- Identify abnormal heart sounds
- Evaluate tremors and other involuntary movements
- Recognize markers of disease in the hands and fingernails
- Examine the tongue
- Examine the shoulder for injuries and joint abnormalities
- Assess blood pressure and abnormal pulses
- Assess lymph nodes in the neck
- Detect fluid in the abdomen and abdominal blood flow
- Perform a rectal exam
- Evaluate a mass in the scrotum
- Test balance and ability to perceive the body’s position in space
- Use a pocket ultrasound device*
If physical examination is only 5% of a diagnosis, it’s a pretty important 5%, and it’s sometimes the difference that makes a difference. Mastering that 5% can take time. So get started now, and revisit the 25 whenever you feel the need.