PART II
CLINICAL EXAMINATION
ASKING
Once all
the above is over, has come the time of a critical step.
It’s about questioning the patient and asking for more details and precision. Never
has a practitioner asked too many questions. Keep asking. Ask for any or relevant details
like about the beginning of symptoms. About, say, the location of a headache,
at the forehead or in the occipital. Is there some dizziness or buzzing at the ear?
What about his sight? Is the vision good? Where is located the painful area? How does this pain present? What's the
pain schedule? What does he do to fight the pain? What does exacerbate it? Many
practitioners go even further. They want to know about the characteristics of
the pain. They also inquire about whatsoever symptoms, whether they
worsen in the morning or at night. Pain is usually more intense at
night.
In family
practice, practitioners inform themselves by asking questions from above
to below, going up to down. They ask about the head and neck, along the ears, the nose, the throat, aka: ENT. Then,
moving down, they review the pulmonary and cardiovascular system, inquiring
about the lungs and heart, the color
of sputum if there is some. Does the patient cough? They ask: do you breathe
easily? Is there some uneasiness in breathing such as dyspnea? Are you
gasping for air? How many pillows do you lie on? Do you wake up at
night with respiratory problems? Do you have to stop in walking? Referring to
the digestive system, they end up questioning about the schedule for ingesting
food. How often do you eat? How much water do you take? Do
some food hurt you more than others one? What do you notice in your
bowel movements? How often do you awake at night to pie?
Practitioners ask for the color of the excreta (feces, urines). The
medical inquiring goes on, emphasizing the walking, the aspect and the size of
the limbs. Is there some asymmetry? Are the members cold or is there some
discoloration? How do fingers or toes look like? Is there some numbness
at the limbs and arms? In fact questioning depends upon many factors and
aspects in medical practice. There is no standard rules and procedure... But,
it pays off by making the review of systems, the so-called ROS from above to
below.
Previously,
the practitioner has been aware of the lifestyle of his patient, his
occupation. A lot of diseases are reported to have been caused by occupational
hazards such as asbestos. It’s well known that ailments linked to farming,
typesetting, cattling and so forth fall into the so-called
occupational diseases. Finally, the practitioner asks about
vaccination status and weight loss or gain.
Heredity and Past history
Needless
to say that grouping these details leads to the coming of light at the end of
the tunnel. Questioning a patient is helping as well in improving the
relationship patient -doctor. Confidence and trust ensue and convince
that the practitioner aims at doing his best to help. The patient doctor
dialogue is special, unique because the resulting openness benefits the both of
sides. Clinicians have in the past become part of the family by sharing
deep-hidden secrets. Furthermore, as mentioned above, a good questioning is a
hallmark of the quality of care the patient can expect from his physician.
Some
clinicians and out-patients services keep a list ready to fill out at
questioning. Reviewing these charts, one has the impression that they serve as
guidelines and rules to follow in order to have an overhaul at clinical
examination. The review of systems (or symptoms) is a
list of questions, arranged by organ system, designed to uncover dysfunction
and disease. It can be applied in several ways.
Shortly
put, when asking for details, the practitioner gets an overview not only about
the current disease for which the patient came to medical office, but also about
the past of patients, their lifestyle and how far they can allege to be safe,
health speaking.
FOOTNOTES
NEXT POST : THE 4 STEP CLINICAL EXAMINATION
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