Sunday, April 17, 2011

PEX Tips

Since we have a Physical-Exam (PEX) skills test this week, I decided to provide a list of some helpful tips for my fellow medical students.

Tip #1: Building Trust

Doctors can be very intimidating while conducting a physical exam. Therefore, here is a way to lighten the mood. Walk into the patient's room wearing nothing but a hospital gown and carrying a doctor's white coat. Then, when you see the patient, pause, and say, "Ooh, that makes much more sense. I'll be right back."

Tip #2: Hearing test

When testing the patient's ability to hear, we were taught to whisper wholesome words into their ears, like "baseball, "apple pie," or "buy war bonds." However, these do not challenge the patient's auditory comprehension very accurately, so here are some more useful phrases to whisper:

"Nice ears"
"You're lookin' good in that gown"
"[chorus from "Drop It Like It's Hot"]"

Tip #3: Fundoscopic exam

While it is considered appropriate to dim the lights for use of the opthalmoscope, it is NOT considered appropriate to turn on Marvin Gaye's "Let's Get It On."

Tip #4: Complete Neurological Test

We are taught to examine simple muscular reflexes and the general mental status of our patient, but we unfortunately do not test for more complex neurological elements. Here is one example of a more advanced neurological test. During the Romberg test, have your patient stand with their feet together and then close their eyes. Then, shove them hard in their chest and watch them fall to the ground. This test has a 98% sensitivity for the patient's ability to feel "betrayal."

Tip #5: Ending the Exam

Make sure you didn't forget any part of the exam! Most beginning students forget to perform the important "Hot or Not" Test, which many physicians contend is a useful predictor for both illicit relations and heart disease.

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