Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Why Physicians Must Not Skimp On The Physical Exam

Like most physicians, I feel extremely rushed during the course of my work day. And every day I am tempted to cut corners to get my documentation done. The “if you didn’t document it, it didn’t happen” mantra has been beaten into us, and we have become enslaved to the quantitative. It’s tempting to rush through physical exams, assuming that if there’s anything “really bad” going on with the patient, some lab test or imaging study will eventually uncover it. Just swoop in, listen to the anterior chest wall, ask if there’s any new pain, and dash off to the next hospital bed. Then we construct a 5-page progress note in the EMR, describing the encounter, our assessment, and plan of care.

Focused physical exams have their place in follow up care, but I strongly urge us all to reconsider skimping on our exams. A fine-toothed comb should be used in any first-time meeting – because so much can be missed as we scurry about. Some examples of things I discovered during careful examination:

1. A pulsatile abdominal mass in a woman being worked up for dizziness.

2. New slurred speech in an edentulous gentleman with poorly controlled hypertension.

3. A stump abscess in a 2-year-old leg amputation.

4. A bullet lodged in the scrotum.

5. Countless stage 1 sacral decubitus and heel ulcers.

6. Melanoma.

7. Rashes that were bothering the patient for years but had not previously been addressed and cured.

8. Early cellulitis from IV site.

9. Deep venous thrombosis of the calf.

10. New onset atrial fibrillation.

11. Thrush.

12. Cataracts.

13. Peripheral neuropathies of various kinds.

14. Lateral medullary syndrome.

15. Surgical scars of all stripes – indicating previous pathology and missing organs of varying importance.

16. Normal pressure hydrocephalus in a patient who had been operated on for spinal stenosis/scoliosis.

17. Parkinson’s Disease in a patient with a fractured hip.

18. Shingles in a person with eye pain.

19. Aortic stenosis in a woman with dizziness.

20. Pleural effusions in a man complaining of anxiety.

Oftentimes I don’t find anything new and exciting that is not already a part of the patient’s medical record. But a curious thing happened to me the other day that made me reflect on the importance of the physical exam. After a careful review of a complex patient’s history, I discussed every scar and “abnormality” I discovered as I did a thorough head-to-toe review of his physical presentation. His aging body revealed more than he had remembered to say… and as our exam drew to a close, he reached out and offered me a fist-bump.

It was charming and unexpected – but made me realize the true importance of the thorough exam. I had gotten to know him in the process, I had earned his trust, and we had built the kind of therapeutic relationship upon which good healthcare is based. No EMR documentation effort was worth missing out on this interaction.

You may not uncover a new diagnosis on each physical exam, but you can gain something just as important. The confidence and respect of the patient.

Does Having An Advanced Degree Make A Better Nurse?

Here is Clara Barton, posing with a new class of graduate nurses who received their nursing education through a correspondence course offered by the Chautauqua School of Nursing. Did you know that some of Clara Barton’s contemporaries did not view her as a legitimate nursing leader because she supported alternative ways of getting a nursing education? It’s kind of ironic that many nursing leaders back then didn’t view the founder of the American Red Cross as an equal. Some things never change.

It’s an old discussion. Are nurses with an advanced degree better nurses? Do they make better leaders and does getting a degree elevate the profession? My blog mother, Kim McAllister, from Emergiblog brought my attention to an article that appears at HealthLeadersMedia.com. The article contains Read more »

*This blog post was originally published at Nurse Ratched's Place*

10 Reasons To Be A Doctor

With all the negative press, the pay cuts, and the uncertainty of healthcare reform, I am approached by people who secretly whisper in my ear, “Would you have your child go into medicine?”

On first blush I am tempted to answer, “Heck no!” given the administrative hassles, the changes in the public’s perception of our profession, the frontload of education, and the long hours involved. But those observations, while real, are superficial at best.

Drilling down with more careful analysis after a challenging weekend on call, I find it worthwhile to stop and ask myself what makes medicine special for those of us crazy enough to subject ourselves to this lifestyle. I decided to put together a list of things that were important to me and would welcome additions from others. Read more »

*This blog post was originally published at Dr. Wes*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »