10 Tips On How To Be An Effective Intern: The Physical Exam

A list of 10 clinical pearls about the physical exam that will help you be a more effective intern, and deliver better patient care. I know that some of these (e.g. tailor your exam to why the patient is in the hospital, don't shortchange exams on patients with disabilities) seem obvious, but I see these concepts forgotten or ignored all of the time. If I had a dime for every progress note whose exam was verbatim: "Chest - CTAB; Heart - RRR, nl S1 S2, no m/r/g; Abd - Soft, NT, ND, normal BS; Extremities - No c/c/e; Neuro - AAOx3, non-focal" irrespective of whether the patient was admitted for a stroke, arrhythmia, or bowel perforation... A few references: The lack of hypotension in the majority of patients with pericardial tamponade: https://jamanetwork.com/journals/jama... The uselessness of auscultation of bowel sounds: https://www.ncbi.nlm.nih.gov/pmc/arti... https://blogs.jwatch.org/frontlines-c... Tips and exam strategies for patients with physical or cognitive disabilities: https://wordpress.uchospitals.edu/tra... https://www.mountsinai.org/about/dive... A wonderful, general resource for learning more about the physical exam: https://stanfordmedicine25.stanford.edu/ The video thumbnail incorporated a picture of a reflex hammer provided by user MacSeagull under CC BY SA 4.0 and downloaded from Wikimedia Commons July 2019.