Throughout my time in Physical Diagnosis I learned all of the important parts of a patient history, what questions to ask and the best manner in which to ask them as well as all of the relevant aspects of the physical exam, how to perform certain special tests and elicit specific reflexes. As many practitioners are known to say, a good history and physical exam are the two most crucial tools a medical professional can possess. I studied the slides, read the book, practiced in lab, forced everyone in my home to undergo countless physical exams and yet when I went to the hospital and met with a real live patient I always felt like everything I knew flew right out of my head. I would forget the order of the physical exam or forget to ask a crucial component of the history, but from forgetting that one time I would learn how not to make the same mistake the next hospital visit, how to remain a little calmer and how to go back and ask the patient if I forgot something critical.
That is probably what changed most for me from the first semester to the second, confidence. I knew that every patient I saw would be different and my time would be limited but that if I sat down and was methodical I was less likely to miss something. I always endeavored to look at the patient as a whole and then zero in on what their problem was. Even though, more likely than not, they would tell me why they were there before I could make my own differential I would still try to take their chief complaint and make my own broad differential so as not to miss a key component of their history. Of course, I am still learning and still making mistakes, but as so many of our professors have emphasized a good history and physical can get you to the accurate diagnosis far more often than lab work or imaging studies can. So, for now, I will take every opportunity to practice my history taking and exam skills especially during my clinical year when I will have an opportunity to observe different types of practitioners and see many different types of patients.
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