ALWAYS ALWAYS ALWAYS ask for permission to touch a patient. Never walk into a clinical encounter (even if it's not an exam) and just start prodding at people. On an exam, that's an automatic failure and in real life, it's just bad medicine. You always ask for permission and tell the patient what you're going to do. "Is it okay if I press on your stomach? I'm just going to listen to your stomach." Also, don't memorize things to say. Don't say "sorry for the light in your eyes" if there's no light (saw a student do this). That will also cost your points. Just be a decent human being. You wouldn't put your hands on anyone before asking, would you? Treat the patient the same.
About this whole asking permission thing. In my OSCEs, I always said stuff like,
"Do you have any questions for me before we start the PE? I'm going to start the physical exam now, ok?"
"I'm looking at your eyes" (with light source) "Everything normal"
"Is it ok for me to unbutton your gown from the back? I'm going to listen to your lung" auscultate 6 back and 4 front
"I'm listening to your heart" auscultate AP "Can you lower your gown and move your breast tissue to the side and up?" auscultate TM
"I'm looking at your stomach. Flat and non distended." "I'm going to listen to your stomach." auscultate 4 quadrants. "I'm going to tap your stomach. Tap 4 quadrants. "I'm going to lightly push your stomach. Let me know if you feel any discomfort." Lightly push 4 quadrants of stomach. "I'm going to deeply push your stomach now. Please let me know of any discomfort." Deeply push 4 quadrants of stomach
Neuro exam:
"I'm going to look at your head for any trauma" Look through hairs with fingers
H test
Sensation test. I personally don't ask for permission here. Touch V1, V2, V3 dermatonies and ask "Everything normal and the same?" for each dermatome
"Smile for me. Close your eyes. Don't let me open your eyes. Open your eyes now. How many fingers I'm holding up?" "Turn your head against my hands" "Shrug your shoulders" "Open your mouth. Said ah.... Move your tongue L and R."
Doc: touch arm from top to down "Everything normal and the same?" for each dermatones
"Hold your hands out" Then check A&O Qs here
"Hold your hands out like this" "Push against my me" Check biceps, triceps, arm grips, etc...
Doc put hands on thighs "Push against me" Doc put hands on calves "Push against me" Doc put hands on ankles "step down like you're stepping on the gas pedal. Move your ankles up now."
"I'm going to check your reflex." Tap knee and achilles and babinski
Doc rub inner and outer knee areas and run down for dermatomes "Everything normal and the same?" multiple times
It takes me about 1-2 mins to run through a complete Neuro exam. However, I'm a very bit scared if I'm going this fast and getting auto fail here. If I ask for permission for every maneuver, it's going to take me forever. Please take a look and give me any feedbacks.