PE Physical Exam

Reviewing previous records, reiterating the reason for the visit, building rapport, interacting with the patient and client, using our knowledge of behavioral cues from patient and humans, taking a patient history, performing a physical exam and recording a SOAP about your findings are all parts of the physical exam!

In this module we concentrate on the hands on physical exam itself with the knowledge that all of the above will be incorporated as we build our skills. Be Curious and Kind, if you dont know? Find out 🙂

The 3 most important things to improve our physical exam skills beyond knowledge are:

1. Practice
2. Practice
3. Practice

Y1 Focus–  Be SAFE; read animals, clients and ourselves, learn SAFE handling and restraint, cooperative care and use of treats/rewards/distraction, build rapport with clients, is a given finding normal or abnormal? Develop Distant and Hands on exam. Look for asymmetry! Practice History taking

Y2 Focus– above + describing abnormal findings using scientific language and measurement in 3 dimensions, create a problem list and start to think of possible diagnostic tests and rule outs.

Y3 Focus– above + think about the logic of each diagnostic test, what is nice to know vs. vital to know? Be competent at Skin Scrapes, Biopsy of skin conditions, blood draw, ear smear, cystocentesis, practice using otoscope, ophthalmoscope, evaluating findings and making assessments, formulating plan for treatment, communicating results in an ordered fashion, and writing SOAPS.

Y4 Focus– above + bringing it all together in an efficient manner within the framework of a given clinic setting, competence with otoscope. ophthalmoscope, honing your communication skills, develop assessment, deliver plan options with client, craft discharge notes for owners as well as recheck plans and client education regarding multiple common conditions. Be mindful of time passing, being efficient and keeping your focus on the patient in front of you and use your team to help out! Better to be thorough and a bit slow while genuinely caring for your patients and clients, than to rush and miss something…it happens, just apologize and improve.

“You miss more by not looking, than not knowing”  Better to say “I’d like to research this with my colleagues and get back to you with a plan,” than “I don’t know what that is…”

“If you don’t look for it you wont find it” Our profession is built on noticing things our clients may or may not have noticed-if clients notice something investigate it, and give an informed opinion/plan.  Do a good through physical exam-you wont regret it, practice so you can do this in a timely manner!

It is a great help to talk briefly about what you are finding as you perform the PE for several reasons:

1. Verbalization of findings communicates what you find to the owner and builds value for them
2. Helps guide further questioning regarding finding ex) have o noticed this? duration? worsening signs?
3. Helps you remember what to record!
4. Lets your instructor’s know what you do well, and where you need to focus to improve

There are two basic types of physical exam, both are of equal value and utility.  It is recommended that what ever type you choose, you perform the physical exam in the same order so as not to miss something.  Resist the temptation to focus only on the declared presenting complaint, and remember the examination begins as soon as you see the animal from a distance:

1. Anatomic examination from nose to tail
2. Examination of systems

Lecture and quiz module coming…