The physical exam has always been one of my favorite parts of medicine. Finding tangible evidence of an underlying pathology is such an intellectually gratifying experience. As a medical student though it can feel like we do physical exam just for the tradition, like we’re just going through the motions, in favor of more sophisticated diagnostic techniques.
Today though, physical exam changed our team’s management of a patient in a way that the CT scan and labs could not. If I had skipped doing a thorough neuro exam (in truth did a subpar exam when I first saw the patients, but went back to do more complete one after realizing I didn’t have enough data), we potentially could have missed a pretty severe etiology of this patient’s altered mental status, which initially seemed relatively benign based on the CT and labs. This was my first time finding cerebellar deficits in a patient who was otherwise minimally mentally altered (he did ok on the MOCA, not great, but ok).
I love finding murmurs. I love hearing crackles and finding pitting edema. Of course not for the patient, but as I mentioned for some reason seeing these manifestations is a gratifying experience purely from a scientific perspective. Like it’s proof that physics and chemistry and biology work more or less in the way you think they do. Especially when you can work towards their resolution or explain why they are benign through the same logic.
nANIMOv 