M.D. The Qi of Taking a Medical History and Performing a Physical Examination

1. Auflage 2021
ISBN: 978-1-6678-0308-1
Verlag: BookBaby
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 216 Seiten

What attitude, what behavior, what philosophical and psychological approach to the clinical practice of medicine will result in excellence in the practice of clinical medicine? Dr. Frank Seinsheimer discusses the basics of the clinical practice of medicine, namely the art and science of medical history taking and physical examination performance. Dr. Seinsheimer presents a cornucopia of true vignettes highlighting inadequate history taking and inadequate physical examination performance to illustrate his points. The many examples presented provide 'second hand experience' to the reader. This book is oriented toward medical providers in their training including medical students, physician assistant students and nurse practitioner students.

Autoren/Hrsg.

M.D.,

Leseproben

Chapter One:
Rambling Permutations of Synaptic Excess Who am I writing this book for? Who is my audience? Why am I writing this book? What is the meaning of life? Just kidding. I am writing this book for medical students, nurse practitioner students, physician assistant students and others embarking on their exhilarating and intimidating journey into the terra incognito jungle of the clinical practice of medicine. Prior to entering the life of clinical medical training, my educational life consisted of the traditional lecture, read, memorize; lecture, read, memorize; lecture, read, memorize, then finally try to understand approach to education. Entering my clinical training, I was stunned by the transition to the random apprenticeship method of clinical teaching. Astounded, dumbfounded, stupefied and startled are other synonymatic adjectives which round out my description of my reaction to my entry into the “practice” of clinical medicine. Clinical medical training is remarkably and profoundly apprentice-like. In elementary school, in high school, in college and in the first two years of medical school my courses were taught within a logical framework in which the flow of knowledge ran from beginning concepts through intermediate concepts to more complex concepts. This seemingly logical method of instruction was the only method of instruction I had experienced throughout my formal educational career. When I began my actual medical clinical training, the method of training, the method of education, the method of instruction changed drastically. I entered a random realm in which my learning depended on whichever patients, happenstance sent my way. I entered a seemingly accidental and arbitrary method of instruction, in which my learning depended on whichever mentors, teachers and patients, Tyche, the Greek goddess of chance, the capricious dispenser of good and ill fortune, placed in my meandering, seemingly drunken walk, life path. I wish in this book to discuss in broad, sweeping strokes some basic concepts and some basic precepts inherent in the “proper” practice of taking a medical history and the “proper” practice of performing a medical physical examination. I wish to provide you with an understanding and a philosophical and psychological approach to your interactions with patients. I wish to provide you with some sense of an outline and advice in how to structure and perform your patient history taking and your patient physical examinations. You will learn about history taking and physical examination performance far more from hands on experience than from didactic presentations. History taking and physical examination performance are not activities you have ever done before. If you are anything like me, you will find taking an excellent medical history and performing and excellent physical examination difficult, bewildering, frustrating and overwhelming at the start. First, you need to know about the multitude of possible disease processes you may see in the patients, you encounter and you don’t yet know them. Second, you need to know the myriad ways this multitude of disease processes cause symptoms and present as physical examination abnormalities. You will need to learn the multitude of ways sociological and psychological factors intermingle and intertwine with biological processes. This learning is a lifelong process of which your medical school years are only the beginning. In the initial years of your clinical training you will form habits which will be lifelong. My purpose in writing this book is to nudge you toward forming good history taking habits and good physical examination performing habits early in your clinical career. This book differs from other instruction manuals which discuss the art of medical history taking and the science of performing a physical examination or is it the science of medical history taking and the art of performing a physical examination? In this book, I insert a multitude of case studies to illustrate my points. Many of these case studies involve physician errors which occurred due to either inadequate history taking or inadequate physical examinations. All of these case studies are true. None are fabricated. I repeat. All of these case studies are true. None are fabricated. The medical histories and the physical examinations, I present, were often deficient due to a failure to observe, evaluate and investigate with sufficient care and thought. Yes! I am harsh in my judgement. After all everyone makes mistakes. But! The consequences of mistakes in medicine are often life ending, life threatening or permanently life altering. Sadly. The mistakes of omission, the mistakes of missing something, the mistakes of failure to be thorough in medicine are common, common, common. Laziness, sloppy thinking and the lack of careful and thorough process are all too common. Some of the case studies I present in this book involve experienced, clever, observant, aware, “On” clinicians who figured out obscure presentations quickly and seemingly effortlessly. In inserting these many case studies, I am attempting to teach you through second hand experience. Many of the cases are from my own personal experience. Other cases I have solicited from friends and colleagues. Because I am an orthopedic and hand surgeon many of my personal case studies come from those areas of medicine. The basic concepts are universal. I have found over many years of practice that the extent of teaching of musculoskeletal medicine to non-orthopedic surgeon medical providers lies somewhere between inadequate and non-existent. Musculoskeletal problems are common. Patients with musculoskeletal problems are seen frequently by internists, general practice physicians, family medicine physicians, emergency room physicians, pediatricians, physician assistants and nurse practitioners. I have seen many missed diagnoses and inferior initial evaluations and treatment of medical and musculoskeletal problems over the years. These misses were at least partially the result of inadequate musculoskeletal medical training. I hope in this book to offer sufficient musculoskeletal instruction to counter this lack. I shall include protocols or lists of what specifics I feel should be part of the history and physical examination of each part of the body. I shall provide frequent examples of patients for whom a limited history, a limited physical examination or more generally a limited overall evaluation led to inferior medical care. Inferior medical histories and inferior physical examinations by definition inevitably lead to inferior medical care. What attitudes and behaviors create the difference between an average, so-so, ordinary, ho-hum, mundane physician or surgeon and an outstanding, excellent physician or surgeon? What is the difference between the truly competent physician and the rest of the pack? The difference lies in the excellent physician’s attitude and approach to life, the universe and the practice of medicine and surgery. Despite the near miraculous advances in medicine and surgery, taking a medical history and performing a physical examination remain the basic and fundamental underpinnings of the practice of medicine and surgery. In my interactions as a patient with specialist physicians, I find a remarkable decrease in the use of the physical examination and a remarkable decrease in the details of medical history taking. Taking the medical history and performing the physical examination form the initial interaction between the medical provider and the patient in most cases. For many physicians taking the medical history and performing the physical examination seems a boring, rote exercise. For the excellent physician, taking the medical history and performing the physical examination is not haphazard. For the excellent physician, taking the medical history and performing the physical examination is the beginning of a planned, controlled investigation performed in a precise, orderly and thoughtful proceeding. The outstanding physician is constantly curious, looking for unexpected or hidden clues which will indicate a problem which is not immediately obvious. For the excellent physician, the medical history and physical examination is similar to a police detective procedural sniffing out the dog which didn’t bark in the night. The difference between the excellent, outstanding physician and the ordinary, average physician is attitude. When you take a medical history and perform a physical examination do you just go through rote motions? OR. Do you have a desperate desire to avoid missing something? I have seen and personally experienced far too much ordinary medicine in my life. SO. Back to “Why am I writing this book?” I am writing this book in an attempt to stimulate you to strive to improve and perfect your diagnostic abilities. I am writing this book to stimulate you to ascend to excellence in the practice of medicine. I am writing this book to encourage you to develop your curiosity, your attitude and your observational skills to help you on this journey. Yes! I am being preachy. Yes! My feelings are strong. I offer no apology for my hectoring. I have written this book as an introduction...