diagnostic skills

[migraineboy]

I have a question for students who are out on clinical rotations now, and I would appreciate honest answers. After two years of clinical rotations, I feel confident in my ability to hear cardiac murmurs, carotid bruits, and various lung sounds. However, I am a concerned about some of my other diagnostic skills. I can only detect very significant abnormalities on a prostate exam, I don't remember ever palpating any thyroid abnormalities, and I still can't see crap on a fundoscopic examination. And honestly, sometimes on examination of somebody's pharynx, the doctor's like "Oh, there's a little erythema and some post-nasal drip" and I'm like whatever....So now I am pulling out my hair and wondering if anyone else out there is in my boat. Anyone? Bueller?

 

[cozmo]

It all comes with experience. I couldn't palapte a thyroid or prostate to save my life when I started 3rd year rotations. I considered myself awesome at heart and lung sounds and marginal with the breast exam (though great with breasts) and just uncomfortable with either genital exam. During your third and 4th years, you are given tons of opportunities to get better, and you can either take them or skim through. I took most of them and skimmed some others. There will always be some attending who can feel a tenth of a millimeter goiter in someone's thyroid or hear a murmur that you swear is not there. Just know that you are probably hearing and feeling some things that others cannot. And don't worry, I think most starting 3rd years feel the same as you, I did, even with the so called "palpatory skills" we got at KCOM.

 

[cozmo]

bump

 

[GreenEyedMonster]

Migraineboy--just to let you know...you are not alone.

There is a mystery of unknown proportion in the fundoscopic exam. I am able to elicit a red reflex and see some random vessels, but beyond that...agh! The thyroid nodule needs to be big enough in order for my clunky hands to pick up.

Don't fret...you will do fine as you start your internship.