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PHYSICAL DIAGNOSIS R. MICHAEL RODRIGUEZ, M.D. ASSOCIATE PROFESSOR OF MEDICINE VANDERBILT UNIVERSITY SCHOOL OF MEDICINE
COURSE STRUCTURE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
EXPECTATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object]
CLASS ETIQUETTE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HOW WILL YOU BE EVALUATED ON THE WARDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
GRADES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
GRADING SCALE HONORS  PASS  FAIL
WHY ARE WE HERE? THE OBJECTIVES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
AS A STUDENT WHAT SHOULD MY GOALS INCLUDE ? ,[object Object],[object Object],[object Object],[object Object]
THE PHYSICIAN PATIENT RELATIONSHIP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ASSESSMENT AND PLAN YOUR GOAL PHYSICIAN PATIENT RELATIONSHIP PHYSICIAN PATIENT RELATIONSHIP PHYSICAL * LAB HISTORY * DIAGNOSIS
OBSERVE, RECORD, TABULATE, COMMUNICATE. USE YOUR FIVE SENSES…. LEARN TO SEE, LEARN TO HEAR, LEARN TO FEEL, LEARN TO SMELL, AND KNOW THAT BY PRACTICE ALONE YOU CAN BECOME EXPERT. MEDICINE IS LEARNED BY THE BEDSIDE AND NOT IN THE CLASSROOM. LET NOT YOUR CONCEPTIONS OF DISEASE COME FROM WORDS HEARD IN THE LECTURE ROOM OR READ FROM THE BOOK. SEE, AND THEN REASON AND COMPARE AND CONTROL. BUT SEE FIRST… THAYER WS. OSLER THE TEACHER. BULLETIN OF THE JOHNS HOPKINS HOSPITAL 1919;30:198-200
3 rd  YEAR H&P A/P H&P PHYSICAL HISTORY INTERVIEW
WHY ARE INTERVIEWING AND PHYSICAL EXAMINATION SKILLS IMPORTANT? ,[object Object],[object Object]
THE INTERVIEW
A PRACTITIONER OF EXPERIENCE DOES NOT SEIZE THE PATIENT’S FOREARM WITH HIS/HER HAND, AS SOON AS HE/SHE COMES, BUT FIRST SITS DOWN AND WITH A CHEERFUL COUNTENANCE ASKS HOW THE PATIENT FINDS HIMSELF/HERSELF; AND IF THE PATIENT HAS ANY FEAR, HE/SHE CALMS HIM/HER WITH ENTERTAINING TALK, AND ONLY AFTER THAT MOVES HIS/HER HAND TO TOUCH THE PATIENT. AULUS AURELIUS CORNELIUS CELSUS 25 BC – 50 AD
THE PHYSICIAN PATIENT RELATIONSHIP  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],MAYO CLIN PROC.2003;78:211-214
WHAT ARE THE FUNCTIONS OF THE MEDICAL INTERVIEW? ,[object Object],[object Object],[object Object],THE MEDICAL INTERVIEW: CLINICAL CARE, EDUCATION, AND RESEARCH. NEW YORK,NY:SPRINGER-VERLAG; 1995:3-19
OBTAINING A CASE HISTORY WHY? ,[object Object],[object Object]
COMMON SHORTCOMING OF THE INTERVIEW PROCESS ,[object Object],[object Object],BECKMAN HB, FRANKEL RM. ANN INTERN MED. 1984; 101:692-696.
BUILDING A RELATIONSHIP WITH YOUR PATIENT (PEARLS) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],THE MEDICAL INTERVIEW: CLINICAL CARE, EDUCATION, AND RESEARCH. NEW YORK,NY:SPRINGER-VERLAG; 1995:3-19 PLATT FW, ET AL. ANN INTERN MED. 2001; 134:1079-1085
PATIENT EDUCATION ,[object Object],KELLER VF, CARROLL JG. PATIENT EDUC COUNS. 1994; 23:131-140
THE FIRST INTERVIEW ,[object Object],[object Object],[object Object],[object Object],[object Object]
WHAT DO I NEED TO DO TO PREPARE MYSELF  PRIOR TO THE INTERIEW ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THE BASIC CONCEPT OF THE INTERVIEW AND PHYSICAL ,[object Object],[object Object],[object Object]
THE INTERVIEW ,[object Object],[object Object],[object Object],[object Object],[object Object]
THE INTERVIEW ,[object Object]
THE INTERVIEW ,[object Object],[object Object],[object Object],[object Object]
THE INTERVIEW ,[object Object],[object Object],[object Object]
I WISH I HAD TO SPEAK OF THE VALUE OF NOTE TAKING. YOU CAN DO NOTHING AS A STUDENT IN PRACTICE WITHOUT IT. CARRY A SMALL NOTEBOOK WHICH WILL FIT INTO YOUR WAISTCOAT POCKET, AND NEVER ASK A NEW PATIENT A QUESTION WITHOUT NOTEBOOK AND PENCIL IN HAND. WIILIAM OSLER 1903 THE STUDENT LIFE
THE INTERVIEW - RULE OF FIVE VOWELS ,[object Object],[object Object],[object Object],[object Object],[object Object]
TYPES OF QUESTIONS ,[object Object],[object Object],[object Object]
TYPES OF QUESTIONS ,[object Object],[object Object],[object Object]
TYPES OF QUESTIONS ,[object Object],[object Object],[object Object]
TYPES OF QUESTIONS ,[object Object],[object Object]
THE INTERVIEW  QUESTIONS TO AVOID  ,[object Object],[object Object],[object Object],[object Object],[object Object]
THE INTERVIEW TECHNIQUES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INTERVIEWING TIPS NONVERBAL BEHAVIORS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SIGNS AND SYMPTOMS ,[object Object],[object Object],[object Object],[object Object]
AN APPROACH TO A SYMPTOM THE SEVEN ELEMENTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
I HAVE A COUGH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
REMEMBER ,[object Object],[object Object],[object Object],[object Object]
REMEMBER ,[object Object],[object Object],[object Object]

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History 1 web 2004

  • 1. PHYSICAL DIAGNOSIS R. MICHAEL RODRIGUEZ, M.D. ASSOCIATE PROFESSOR OF MEDICINE VANDERBILT UNIVERSITY SCHOOL OF MEDICINE
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 8.
  • 9.
  • 10.
  • 11. ASSESSMENT AND PLAN YOUR GOAL PHYSICIAN PATIENT RELATIONSHIP PHYSICIAN PATIENT RELATIONSHIP PHYSICAL * LAB HISTORY * DIAGNOSIS
  • 12. OBSERVE, RECORD, TABULATE, COMMUNICATE. USE YOUR FIVE SENSES…. LEARN TO SEE, LEARN TO HEAR, LEARN TO FEEL, LEARN TO SMELL, AND KNOW THAT BY PRACTICE ALONE YOU CAN BECOME EXPERT. MEDICINE IS LEARNED BY THE BEDSIDE AND NOT IN THE CLASSROOM. LET NOT YOUR CONCEPTIONS OF DISEASE COME FROM WORDS HEARD IN THE LECTURE ROOM OR READ FROM THE BOOK. SEE, AND THEN REASON AND COMPARE AND CONTROL. BUT SEE FIRST… THAYER WS. OSLER THE TEACHER. BULLETIN OF THE JOHNS HOPKINS HOSPITAL 1919;30:198-200
  • 13. 3 rd YEAR H&P A/P H&P PHYSICAL HISTORY INTERVIEW
  • 14.
  • 16. A PRACTITIONER OF EXPERIENCE DOES NOT SEIZE THE PATIENT’S FOREARM WITH HIS/HER HAND, AS SOON AS HE/SHE COMES, BUT FIRST SITS DOWN AND WITH A CHEERFUL COUNTENANCE ASKS HOW THE PATIENT FINDS HIMSELF/HERSELF; AND IF THE PATIENT HAS ANY FEAR, HE/SHE CALMS HIM/HER WITH ENTERTAINING TALK, AND ONLY AFTER THAT MOVES HIS/HER HAND TO TOUCH THE PATIENT. AULUS AURELIUS CORNELIUS CELSUS 25 BC – 50 AD
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30. I WISH I HAD TO SPEAK OF THE VALUE OF NOTE TAKING. YOU CAN DO NOTHING AS A STUDENT IN PRACTICE WITHOUT IT. CARRY A SMALL NOTEBOOK WHICH WILL FIT INTO YOUR WAISTCOAT POCKET, AND NEVER ASK A NEW PATIENT A QUESTION WITHOUT NOTEBOOK AND PENCIL IN HAND. WIILIAM OSLER 1903 THE STUDENT LIFE
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38.
  • 39.
  • 40.
  • 41.
  • 42.
  • 43.