A few weeks ago, we second years were tested on our clinical skills of a complete physical exam. While any doctor could tell you that you will likely never do a complete physical exam on your patient, it’s important to know each aspect of physical exam skills so that you can focus your exam on your specific problem, that is, have a tailor-made exam to fit each patient. For example, if a woman came in with a chief complaint of a sore throat, it might not be necessary to do a rectal exam on her.

The complete physical exam tests several things. To begin the exam, as we always do, the vital signs are taken. This includes blood pressure, radial pulse, respiratory rate, and overall appearance of the patient. For fun, we also had to take a bunch of pulses - radial, ulnar, carotid, femoral, dorsalis pedis, and posterior tibial pulses. Then we work out way through the examination portion, which can really be done in any order.

HEENT, Back, Thorax, Abdomen: Look at the scalp, look at the eyes, do some tests on the functionality of the eyes, examine the retinas, look at the ears, nose, mouth (“say ah”, “stick out your tongue”), throat. Check the thyroid, check for enlarged lymph nodes, then its on to the back. Look, feel, punch the CVA, check symmetry during inspiration, percuss, auscultate. To the front, listen to the lungs, listen to the 4 heart valves, check the jugular. On to the belly, look-listen-feel (in that order), then feel for the liver edge, percuss for the upper limit and estimate its size. Fairly simple.

Then finish up the cranial nerves (“have you noticed any changes in your ability to smell?”), touch the face in 6 places (checking the trigeminal’s 3 divisions), feel the masseter as the patient clenches his teeth. Wrinkle the forehead, puff the cheeks for the Facial Nerve (CNVII). Do a little Rhine and Weber, whisper a number (CNVIII), then test the strength of the trapezius and sternocleidomastoid and-voila-the cranial nerves are complete.

On to musculoskeletal exam: Go through the extremities and check the patient’s contractile ability - note any asymmetery between the right and left. Look and feel the joints, then assess the range of motion of hands, wrists, elbows, shoulders, spine, hips, knees, and ankles. After arms and legs are done, do their reflexes. Brachioradialis, biceps, triceps, patellar, achilles, and plantar.

Then, its time to move on to cerebellar function examination. These tests are done to check your coordination, and if you’re way off then we’ll look into any possible problems with your cerebellum. The tests are kind of fun - supinate-pronate hands as fast as possible; touch your nose, touch my finger; slide your heel down your shin. Test for sensory in the extremities, check the positioning sense of the big toe, test vibratory sense in the feet. Finally have the patient stand up, feet together, and close his eyes and hope he doesn’t fall over (called the Romberg Test). And that’s it. 30 minutes of a complete exam summed up in a few sentences!


The clinical skills experiences are really nice to break up the monotony of day-to-day studying. Its so nice, I can’t even begin to explain how nice it is, to be able to actually see a patient - even if it’s a fake one. Sometimes I feel so lost in my lectures and books that I loose sight of why I’m here - and that’s to help people. These quick exposures to the clinical side of medicine help to keep me motivated, and I welcome the opportunities to work on my clinical skills with high enthusiasm.

Being a doctor with a great bedside manner is one of my highest aspirations; there is nothing worse than being told you’re sick by someone who treats you with disdain or makes you feel uncomfortable. To me, being the most kind and compassionate doctor would be so much more of an honor than to be the smartest doctor. Don’t get me wrong, it would be fabulous to be #1 in the class!, but I place much more value on the personal side of medicine. I know when I finish through all of the classes that are in medical school, and pass all of my boards and shelf exams, I will be more than adequately equipped to handle my patients’ physical needs. The real difference between a great doctor and an amazing doctor is how he/she can handle your emotional needs, how he/she can make you feel when he/she is explaining what’s going on in your body, and trustfully reassure you in whatever way that he/she can. Allowing time to be spent with patients during the first two years of medical education helps to build up our empathy and bedside manner, and they are great opportunities to brush up on patient interaction before we're really thrown into it at the beginning of third year.