Doing the physical exam for the first time as a medical student

Armed with tools I have never used or seen before I entered a physical exam practice room for the first day of learning.

Having finished history-taking practices last semester, we were now beginning a new chapter, learning to take a head-to-toe physical exam. Before class began, we were told to read a book and watch some videos on how to do the head and neck exam and how to take vital signs. But, these preparations could not teach me how to feel in a stranger’s mouth or what to look for in a nose. No amount of reading could help me to break all social norms and become a real doctor.

My partner graciously went first and following the outline we were given, he started by taking my pulse and then my blood pressure. I quietly reminded him to wash his hands before he did anything to me and he hilariously listened to me ,”the patient,” as I helped happily guide him on his first examination. Lucky for me, my partner and I are good friends already. However, good friends generally do not feel each other’s tongues or look at their nasal cavities … so after today, we knew we would enter a new realm of friendship.

Step-by-step he followed the instructions, feeling for my thyroid, feeling for my lymph nodes (there are way too many places to find all of these and I swear I can only feel like 4 of them), sweeping my mouth and under my tongue for any abscesses or tumors (obviously, for the most part student patients represent  “normal”, even though we have heard horror stories of things being found during these practices and during the radiology workshops we have in Anatomy), and watching the range of motion of my neck. The first to use an our combination ophthalmo/otoscope, my partner learned the proper hand movements from our proctor and then casually put it into my nose.

Unsure if we had even put it together right, let alone charged it correctly for use, the fact that a light even turned on in the instrument was amazing to us. Yet, the second the instrument entered my nose I felt a reaction somewhere between a sneeze and pain and my face sort of scrunched up. Not wanting to embarrass him, and sure that I would be doing the same thing to him 10 minutes later, I did not comment and tried so hard to hide my facial expression. However, the proctor soon noticed and hinted to my partner to, “look at his patient,” and with that my friend saw my face, removed the device, and suddenly my eyes teared up. Embarrassed myself, I urged him to go on and promised that he did not hurt me at all.

30 minutes later, it was my turn to try.

When I went from patient to doctor, it was as if I completely forgot every step I had just seen my partner do. I took his pulse. 44. Too low, I thought, that just did not seem right.  My proctor assured me that a healthy athletic person could easily have a pulse lower than 60 and that normal is often lower than we were taught, and I suddenly felt reassured. I then measured his respiratory rate … 10. Low again, I thought, and this time seemingly impossible. He was obviously breathing, but perhaps he knew I was counting and he consciously slowed his rate. Or maybe I got confused by “faking” to take a pulse (how you take respiratory rate without the patient knowing), and looking at a watch, and counting breaths … all at the same time. So much for my self-touted skill of multi-tasking. Worried that I might possibly be the worst future doctor ever, I finally succeeded in taking a vital sign when I got a normal blood pressure reading. Sure, it took me long enough to figure out when the pump was open or closed, and to tell if I was inflating or deflating it, but once I figured out the technology, at least the number I got finally made sense.

Following the vital signs, I performed a head and neck exam on my partner. It is hard to explain how it is to suddenly put on gloves and feel the tongue of someone else, especially across gender barriers, but let’s just say it is strange. The only way to get over it is to keep doing it until it does not feel weird. In fact, to cut the awkward tension my partner often laughed or interjected jokes. For example, while looking up his nose with the ophthalmo/otoscope he asked me if the hair on his head was the same color as his nose hairs (along the lines of “does the carpet match the drapes” but in an alternate setting). I could not help but giggle and with that I easily forgot that I was deathly afraid of making his eyes water, or gagging him with a tongue depressor.

Sure, I may not know what I am looking for up a nose or in a mouth and to me a nose is just a nose, but hey, I finally learned to start examining a patient and that is a step in the right direction.

Jessica Gold is a medical student.

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  • richard scottr

    Nice post, written with humor and insight. Both needed in growth towards becoming a physician. There are few guideposts available and often nobody to point them out.
    Dr. Gawande started his essays as a beginning doctor. I often suggested they be in the medical school reading list.

  • http://drpullen.com health blog

    It’s been a long time, but we’ve all been there. Nicely written post, keep on writing.

  • Molly Ciliberti, RN

    A friend of mine while in his residency for OB/GYN said the only thing he got out of his first 50 pelvic exams was a warm hand.

  • Mollt

    Thanks so much, Jessica, for a funny, honest window into that first exam–I’m about to start in the fall and am terrified of all the same things!

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