Full Physical Exam!

Today was our 1st final Doctoring OSCE (exam). Doctoring is the course in which we learn how to take patient histories, perform physical exams, talk about ethics etc. I actually was fortunate to do some curricular work last summer and throughout this year with this course (and it has been a fantastic experience!)

In today's OSCE, we had to conduct a full physical exam on our patient - head, eyes, ears, nose, mouth, neck, heart, lungs, abdomen, musculoskeletal - except for the Neuro exam and the female GYN exam (which I learned to do last week and will be posting about it soon) - all this in 25 minutes. Last summer, when our course director told me that we would be expected to do this in February, I had a hard time figuring out how we would be able to do so much in so little time. Well, I'm not sure where the months between last summer and today have disappeared, but now the time was here.

For the last few OSCEs, I practiced with 2 of my close friends - and so we met up yesterday (Wednesday's are our days off.. I mean "Self-Directed Learning Days") to get ready for the OSCE and to give tips to each other. Not only do we learn by performing the exam on each other but in fact, a lot of learning is also done through serving as the patient. You'd be surprised by how much you learn when someone actually does the exam on you. If my memory serves me well, this was probably the first full physical exam that I have ever received.

One of us made a comment about how this could potentially be the one of the last times when we do a complete physical exam on a patient (hopefully not). With the limited amount of time that physicians have with their patients these days, it seems that it is more common and perhaps practical to do focused physical exams on the organ systems that a patient may be having trouble with. I have been working with an Emergency Medicine physician (my community mentor) for the last 2 years and a full physical is simply not done in that setting.

I felt quite prepared for today's OSCE. The checklists that we follow for the physical exam are near and dear to me since I have spent a lot of time formatting them and working with them since last summer. It all came full circle - I was now expected to do everything on the checklists - and we have had a lot of practice with our peers, standardized patients and with real patients at our community mentor site.

Well back to the point - I went in and completed the full physical exam in the allotted time. I had a very nice standardised patient who made me very comfortable performing the exam. Time after time, I continue to realise how nice it is to have a cooperative patient and how useful it is to explain what you are doing to the patient so that they are not surprised by what you are doing!

The 25 minutes flew by and I must admit, I felt like a doctor for a brief moment. I had succeeded in examining a patient from head-to-toe. A good goal accomplished.

As I was writing up my findings, that feeling quickly dwindled away as I realised how much more difficult it was going to be do perform a physical exam on patients with actual conditions and when everything was not normal. How much more I had to learn. How we will be trained to integrate the science we're learning with these findings. As I left that room, there was one thing I was sure about - I am very excited for clinical rotations to start in about 3 months time!