tag:blogger.com,1999:blog-30499448.post8856155868028532846..comments2024-02-18T13:53:30.168-08:00Comments on Surgeonsblog: Soft TouchSid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-30499448.post-63849108277590544752007-05-15T10:46:00.000-07:002007-05-15T10:46:00.000-07:00Amen x3. "I've taken out appendices without the be...Amen x3. <BR/><BR/>"I've taken out appendices without the benefit of an ultrasound or CT scan...Nowadays it feels a lot like insanity, hanging out there too far."<BR/><BR/>I simply consider that as being a doctor--a diagnostician being just part of that title--not just a "cutter." All the technology is a confirmation, not a subtitute, for the diagnosis.<BR/><BR/>Regarding the retina, I too remember the thrill last year of finally finding the optic disc amidst serpentine projections of various unnamed vessels. I was so excited! That was dampened quickly when my classmate, who had to sit patiently for an unnatural amount of time with a 5 gigawatt light in his eye said, "I hope my blindess was worth it." heh.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-30979063448601192742007-05-12T21:00:00.000-07:002007-05-12T21:00:00.000-07:00"As inspiring as it is to be allowed to operate, l..."As inspiring as it is to be allowed to operate, literally to enter into a bond and to breach boundaries of flesh that only a few are privileged to do, the physical exam has a special intimacy of its own."<BR/><BR/>So eloquently said. Good post! :)SeaSprayhttps://www.blogger.com/profile/07906503090688697222noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-61725602587079093662007-05-11T10:29:00.000-07:002007-05-11T10:29:00.000-07:00TryOrient, JM: Sapira's Art & science of bedside d...Try<BR/><BR/>Orient, JM: Sapira's Art & science of bedside diagnosis, 3e. 2005<BR/><BR/>DeGowin, Swartz, Bates & Sidel's books are the most simple & recommended physical diag bks.<BR/><BR/>PocketRadiologist has a nice little series <BR/><BR/>and Silen: Cope's Early Diag Actue Abdomen is always interestingAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-3227915978577300452007-05-07T12:11:00.000-07:002007-05-07T12:11:00.000-07:00Who needs a chest X-ray if you can demonstrate whi...Who needs a chest X-ray if you can demonstrate whispering pectoriloquy?<BR/>(Nice name for a yacht...)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-26263852832509338912007-05-06T16:36:00.000-07:002007-05-06T16:36:00.000-07:00I appreciate when a doctor spends the time to do a...I appreciate when a doctor spends the time to do a physical exam. I've usually been able to point out details of my problem, and ask questions, that wouldn't be possible if the doctor just says something like "I'm sending you for a CAT scan." I also feel that the doctor has more concrete information about me and my problem when he/she has done an exam.<BR/><BR/>I don't have similarly positive feelings when I have had a sleepy, harried resident do a physical exam, as if it's an onerous chore to be gotten through as quickly as possible. Which, I gather, is exactly what they are being trained to think.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-14179844275108034372007-05-06T03:54:00.000-07:002007-05-06T03:54:00.000-07:00So, radiology or thumping? One is expensive, one ...So, radiology or thumping? One is expensive, one isn't.<BR/>Does it just come down to reliability?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-87806878660034315282007-05-06T03:43:00.000-07:002007-05-06T03:43:00.000-07:00I am a Massage therapist that got here through a G...I am a Massage therapist that got here through a Google alert. Besides the palpation training in school I worked for a chiropractor that had a system for recording palpation on the client chart. At first I just recorded his findings as he called them out but eventualy on routine clients I was expected to do the periodic exam. I also got to take and mesure the x-ray film. So I developed a corilation between what I was fealing and what I saw. after 12 years I have become very adept at seeing with my hands ad feeling with my eyes.<BR/>Hans Albert Quistorff, LMP<BR/>Antalgic Posture Pain SpecialistHansMassagehttps://www.blogger.com/profile/10789848416034379910noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-6819961101964892382007-05-05T13:03:00.000-07:002007-05-05T13:03:00.000-07:00Neurologists are in a bit of the same thing as wel...Neurologists are in a bit of the same thing as well. When I was in med school was when the first CT scans came out, in my residency, MRIs. <BR/>There are certainly many heated discussions I recall in the early days of scanning about the significance of findings on neurologic exam, only to be disproven by the scan.<BR/>At the same time, listening to a neuroradiologist talk about what they think is going on with the patient can be humorous -- the imaging info is not very useful without the clinical connection.Greg Phttps://www.blogger.com/profile/18422487877167541900noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-48074889584756547722007-05-05T10:11:00.000-07:002007-05-05T10:11:00.000-07:00Great post, as always, Doc (I missed Car Talk toda...Great post, as always, Doc (I missed Car Talk today, but see if I can hear an archived copy to see if you made it on!)<BR/><BR/>I'm in my first year of surgery residency, and am somewhat conflicted - I absolutely love the idea of having better physical exam skills, but when you're busy (and what intern ever isn't) it's just so much easier to order a test or study to "rule in or rule out" a particular diagnosis (such an odd turn of phrase - maybe a subject for a future post of yours?).<BR/><BR/>Plus, the liability. Will today's climate accept the oft-quoted "10%" false positive rate for clinically-diagnosed appendicitis? I still see people go to the OR without scans these days, the "slam-dunk" ones clinically, but I'm always (pleasantly) surprised... and I always make sure to ask what the appendix looked like when they got in.<BR/><BR/>My program has just about mandated that all central lines be done with ultrasound.... not because they doubt our abilities, but because JCAHO is almost mandating it (although, in all honesty, it would have prevented a poor guy last year from getting a carotid cannulated...<BR/><BR/>Anyway, there are a few esteemed graybeards left in my program that heavily push PE skills, and woe to the resident who can't describe the findings, so we are left to heavily mine their experience, despite realizing that we will most likely never achieve the same level of physical exam acumen... (I dare say you know and have trained with some of them, being in the same part of the country).<BR/><BR/>Great post, as always, Doc!Anonymousnoreply@blogger.com