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GUIDE TO PATIENT ENCOUNTER NO. 1: HISTORY-TAKING AND PHYSICALEXAMINATION

July 1, 2011

1. The class will be divided into 25-26 groups, each composed of 4-5students each. Each small group will be assigned to 1 clinical preceptor.

2. In this activity, your preceptor will engage your small group in aninteractive discussion with demonstration and return-demonstration ofHistory-Taking and Physical Examination with more emphasis on the VitalSigns, Head and Neck (overview only, because the more detailed approach isreserved for specific organ modules throughout the schoolyear), anteriorthorax, posterior thorax and abdomen. You may skip the Neuro Exambecause this will be discussed separately in a plenary lecture.

3. You are advised to study your official textbook Bates' Guide to PhysicalExamination and History Taking, Ninth Edition and review its video cd on PE.

4. Your first task is to make sure that your group is complete with all thematerials which include a bp apparatus, stethoscope, penlight, and tonguedepressors, otosope, and ophthalmoscope, necessary in taking the healthhistory and performing a complete PE of a patient.

5. As a group, your next task is to elicit a complete health history from theinvited patient. To make this activity more organized, it would be of help todivide the work among yourselves. For example, you may assign eachmember to ask about the chief complaint, HPI (this is the body of your historyso more historians are needed here to invite the patients story), Past MedHx, ROS, etc. It would be good too to take turns in your questioning and

avoid asking the patient all at the same time. Be organized and observeproper sequencing.

6. Under the supervision of your clinical preceptor, your next task is to doa complete Physical Examination of an actual patient but due to timeconstraints, the following organ system PE may be waived if NOTINDICATED, and are therefore optional:

a. Ophtha: Tests of Vision, Visual Field Testsb. ENT: Auditory tests, Weber, Rinne, Rombergc. Complete Neurologic exam

d. Genital and Rectal examse. Musculoskeletal System

7. The following are the salient points in history-taking and physical examination which areexpected of you:

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HISTORY-TAKING

In taking a patients health history, the student is expected to:ATTITUDE

Greet the patient

Introduce self

Verify patients identity

Acknowledge patients companions

Establish rapport

Explain process of history taking

Treat the patient with dignity and respect

Thank the patient at the end of the interview

KNOWLEDGE

Gather general dataIdentify the chief complaint

Elicit history of present illness

Elicit past medical history

Elicit family history

Elicit review of systems

SKILLS

Begin by asking open ended questions

Progress to focused questions

Minimiz interrupting patient

Ask questions using simple terms

Ask clarificatory questions

Clarify symptoms using PQRST:Precipitating/ProvokingQualityRadiationRelievingSeverityTiming

PHYSICAL EXAMINATION

In performing a physical examination, the student is expected to:ATTITUDE

Explain process of physical examination

Obtain consent for physical examination

Respect patients privacy

Explain before each action

Conduct self with dignity

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With the patient lying supine,Cardiovascular System

Observe the JVP, carotid pulsations; when indicated, measure the JVP appropriately, listen tocarotid bruits, when indicated;

Inspect and palpate the precordium

Note the location, diameter, amplitude and duration of apical impulse;

Auscultate; listen at the apex, lower sternal border with the bell;

listen at each auscultatory area with diaphragm

Abdomen

Inspect, auscultate, percuss abdomen; Assess the liver and spleen by percussion, then palpation

Lower Extremities

Examine the legs, palpates for pitting edemaWhen indicated, palpate the femoral, popliteal pulses, inguinal lymph nodesNote any deformities, limitation of range of motion

8. Your final task is to submit an INDIVIDUAL type-written write-upon your patients history and PE (following the format taught to you by Dr.Michelle De Vera in her lecture ) on July 4, 2011, Monday, to be collectedand submitted by your student beadle to our admin staff, Ms. Maricel Go notlater than 12:00 pm.

Thanks and good luck!

Amiel C.E. Dela Cruz, MDMedicine Coordinator