How to perform female exam?

[lollol]

Till now i only performed physical exam at males.

But in a few weeks, we'll have to examen also female patients. Some of them will be real, and some will be co-students.

So im wondering, how do i perform a chest exam (mainly auscultation) on a female patient. I dont need to know anything about pelvic exam, etc. Only for chest exam.

So:

1) How to perform chest exam on female real patient. i.e. a patient without bra. What if she has big breasts. How do u keep professional and perform a exam. Do u ask her to lift her breast up for auscultation of the mitral valve?

2) How to perfom a chest exam on co-students with bra. I might be a bit confused, but i think most of the (sports) bra's cover the heart auscultation areas. Isnt it?


I mean, with a male its simple. Just visualise where the mitral valve is. But with women, the breast lies before it.

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[racerx]

Till now i only performed physical exam at males.

But in a few weeks, we'll have to examen also female patients. Some of them will be real, and some will be co-students.

So im wondering, how do i perform a chest exam (mainly auscultation) on a female patient. I dont need to know anything about pelvic exam, etc. Only for chest exam.

So:

1) How to perform chest exam on female real patient. i.e. a patient without bra. What if she has big breasts. How do u keep professional and perform a exam. Do u ask her to lift her breast up for auscultation of the mitral valve?

2) How to perfom a chest exam on co-students with bra. I might be a bit confused, but i think most of the (sports) bra's cover the heart auscultation areas. Isnt it?


I mean, with a male its simple. Just visualise where the mitral valve is. But with women, the breast lies before it.

1. Yes. You can ask the patient to hold up her breast while you feel for PMI and listen at the mitral location.

2. You can always slide the head of the steth under the edge of the sports bra when working with a fellow student. Whatever you do DON'T listen throught the bra cloth. I have heard that you can get major points off in the step 2CS for that. Besides, there is a pretty definite degradation in sound quality, IMO.

 

[JonnyG]

Till now i only performed physical exam at males.

But in a few weeks, we'll have to examen also female patients. Some of them will be real, and some will be co-students.

So im wondering, how do i perform a chest exam (mainly auscultation) on a female patient. I dont need to know anything about pelvic exam, etc. Only for chest exam.

So:

1) How to perform chest exam on female real patient. i.e. a patient without bra. What if she has big breasts. How do u keep professional and perform a exam. Do u ask her to lift her breast up for auscultation of the mitral valve?

2) How to perfom a chest exam on co-students with bra. I might be a bit confused, but i think most of the (sports) bra's cover the heart auscultation areas. Isnt it?


I mean, with a male its simple. Just visualise where the mitral valve is. But with women, the breast lies before it.

Most women leave their bras on for exams even at the cardiologist. Just ask them to lift their breast for you or if they dont move it enough use the back of your hand to push it out of the way.

 

[UnderdogMD]

You know how when you grab a woman's breast and you feel it...and it feels like... a bag of sand.

 

[ZagDoc]

Most women leave their bras on for exams even at the cardiologist. Just ask them to lift their breast for you or if they dont move it enough use the back of your hand to push it out of the way.

Exactly. If you do it yourself, back of the hand is the appropriate way. Palm side can more easily be misconstrued as an inappropriate touch.

 

[KECKington]

You know how when you grab a woman's breast and you feel it...and it feels like... a bag of sand.

I wouldnt know I am too busy playing with my action figures!

 

[45408]

Most women leave their bras on for exams even at the cardiologist. Just ask them to lift their breast for you or if they dont move it enough use the back of your hand to push it out of the way.

One of my preceptors said that you'll look really wet behind the ears if you ask a patient to move her breast herself, but that's what I had just done a little bit ago. 😛 The next time, I'll probably try to use the back of my hand, but it sure would be easier if they'd just take off that darn thing, especially since older women seem to wear ones that are really heavy duty, even if they don't have large breasts.

 

[mjl1717]

1. Yes. You can ask the patient to hold up her breast while you feel for PMI and listen at the mitral location.

2. You can always slide the head of the steth under the edge of the sports bra when working with a fellow student. Whatever you do DON'T listen throught the bra cloth. I have heard that you can get major points off in the step 2CS for that. Besides, there is a pretty definite degradation in sound quality, IMO.

Silly jokes and novice thinking aside!

I definitely agree with #1 here.

 

[lollol]

Do women really tend to keep their bra's on??

Maybe thats something common in the US, but here in europe we are taught to ask women to remove their bra's...

 

[racerx]

One of my preceptors said that you'll look really wet behind the ears if you ask a patient to move her breast herself, but that's what I had just done a little bit ago. 😛 The next time, I'll probably try to use the back of my hand, but it sure would be easier if they'd just take off that darn thing, especially since older women seem to wear ones that are really heavy duty, even if they don't have large breasts.

Hmmm...we were taught by our preceptors to ask the patient to lift the breast up for us when performing cardiac auscultation / PMI location.

The only time we were taught to use the back of our hand is to:
-queue the patient to let her knees fall open at the start of a pelvic.

-to help "delateralize" the breast tissue when performing palpation during a breast exam (if the patient has pendulus breasts that lateralize upon laying supine).

I'd be very surprised if even occurs to a patient to judge if someone is "wet behind the ears" by something like that. They'd have to be veritable "doctor gourmets".

 

[racerx]

Do women really tend to keep their bra's on??

Maybe thats something common in the US, but here in europe we are taught to ask women to remove their bra's...

OP,

Didn't realize you are in Europe. Luckily for you, and your bank account, the step 2CS info won't apply to you.

 

[doctorFred]

i was also taught that the "proper" way to go about it is to ask the patient to lift their breast out of the way. it's a little awkward at first but like everything else, it gets routine.

 

[Twitch]

-> Thinks OP is a troll. Either that or know how to make a heck of a first impression:

Post #4 : "How to do female exams?"
Post #5: "Bra's off here in Europe"

 

[PeepshowJohnny]

Dr. Robert Rey says the first part of the physical exam is to tell the patient how incredibly hot and sexy she is.

 

[Law2Doc]

How do u keep professional and perform a exam.

If you think and act like it is something prurient and sexual, you are probably not ready to do this kind of exam. You are going to be listening with stethescopes on patients of all ages and sizes, and need to get into your clinician role, whether it is an attractive 20 year old or a morbidly obese grandmother. I agree with the above that asking someone to move their breasts highlights that you are noticing them, and I would agree sound rookie-ish; you'll never see that on the wards or in clinic; you just nudge them out of the way. If you just matter of factly put your stethoscope where it needs to be, edging the breast out of the way with the back of a hand, knuckle, etc, nobody is going to care as much as OP's post suggests. In a year or so you are going to be expected to examine the breast itself as part of the exam anyhow, not just move it, so time to lose the anxiety about it.

 

[njbmd]

First rule of thumb, you don't do any kind of exam on any person (male or female) without explaining what you are doing and why. If your patient is a child, you explain to the parents. If you start there, and gain the trust of your patient, any portion of the exam becomes professional.

To the OP: how did your preceptor instruct you in performing a cardiovascular or respiratory exam on patients? You need to review what you have been taught before you start practicing on anyone. Learning how to properly evaluate patients is not something that you read from a message board or out of a book. Get an experienced preceptor to instruct you in these exams techniques.

 

[racerx]

I agree with the above that asking someone to move their breasts highlights that you are noticing them, and I would agree sound rookie-ish; you'll never see that on the wards or in clinic; you just nudge them out of the way.

That's odd; ALL of our clinical medicine docs taught us to ask the patient to lift their breast out of the way. Some of them have been practicing 40 years and are hardly "rookie-ish". They must not be as cool as your preceptors.🙄

1. It is not a crime to "notice" that a portion of a patient's anatomy is impeding the exam. Nor is a crime to ask for a patient's assistance.
2. Have already seen it on the wards AND in the clinic.
3. It allows the patient that may be uncomfortable with people touching certain areas of their body to maintain their modesty.
4. It is a bit more patient-centered than simply backhanding the breast out of the way. Get the patient involved, etc.
5. Never, ever, ever touch a patient's breasts without permission, even with the back of the hand. For those patients that are super-sensitive about such things, it can be seen as inappropriate (and be reported as such). Also, it could convey a bit of a paternalistic attitude to the patient.
6. I think it is more prurient to pretend a person's breasts don't exist than to aknowledge that they are impeding the exam by including the patient in their exam.

While it may be rookie-ish and uncool, it is the way my colleagues and I were taught, by physicians with decades more experience than any of us have, and it is the way expected at my school. As such, it is the way we will do it. I am not concerned with appearing to a patient that I am rookie-ish. I am concerned with providing thorough care to the best of my abilities.

The average patient is not a healthcare connoisseur. They have seen variations in exam techniques and probably don't split hairs as fine as we do here. I can't imagine a patient thinking, "hmmm, he had me lift my breast out of the way. He must be a newby." I can imagine the patient thinking:

A. "He just touched my breast without permission!!!" (don't matter if it's a backhand or palm)

or, more likely

B. "I wonder if everything is OK? Did he hear anything wrong?"

YMMV

 

[Toohotinvegas33]

Dr. Robert Rey says the first part of the physical exam is to tell the patient how incredibly hot and sexy she is.

😱

 

[lollol]

-> Thinks OP is a troll. Either that or know how to make a heck of a first impression:

Post #4 : "How to do female exams?"
Post #5: "Bra's off here in Europe"

Srry bro, but the question i asked was very serious... its not a troll.

If you think and act like it is something prurient and sexual, you are probably not ready to do this kind of exam.

Im not thinking in ANY way about something sexual...

Just wanted to make this clear: its not about MY feelings, but the PATIENTS feelings. What THEY might think of me as a rookie med student.

For the rest: thnx everybody for their input 🙂

@njbmd. We DID exams, but limited to males.

 

[mjl1717]

That's odd; ALL of our clinical medicine docs taught us to ask the patient to lift their breast out of the way. Some of them have been practicing 40 years and are hardly "rookie-ish". They must not be as cool as your preceptors.🙄

1. It is not a crime to "notice" that a portion of a patient's anatomy is impeding the exam. Nor is a crime to ask for a patient's assistance.
2. Have already seen it on the wards AND in the clinic.
3. It allows the patient that may be uncomfortable with people touching certain areas of their body to maintain their modesty.
4. It is a bit more patient-centered than simply backhanding the breast out of the way. Get the patient involved, etc.
5. Never, ever, ever touch a patient's breasts without permission, even with the back of the hand. For those patients that are super-sensitive about such things, it can be seen as inappropriate (and be reported as such). Also, it could convey a bit of a paternalistic attitude to the patient.
6. I think it is more prurient to pretend a person's breasts don't exist than to aknowledge that they are impeding the exam by including the patient in their exam.

While it may be rookie-ish and uncool, it is the way my colleagues and I were taught, by physicians with decades more experience than any of us have, and it is the way expected at my school. As such, it is the way we will do it. I am not concerned with appearing to a patient that I am rookie-ish. I am concerned with providing thorough care to the best of my abilities.

The average patient is not a healthcare connoisseur. They have seen variations in exam techniques and probably don't split hairs as fine as we do here. I can't imagine a patient thinking, "hmmm, he had me lift my breast out of the way. He must be a newby." I can imagine the patient thinking:

A. "He just touched my breast without permission!!!" (don't matter if it's a backhand or palm)

or, more likely

B. "I wonder if everything is OK? Did he hear anything wrong?"

YMMV

1) I could not have communicated this any better..-Good communication racerx..

2Great communication and I cant impress this enough, in my opinion is probably more then half of this medical saga!!

3)Also asking her to move her breast to the side respects her autonomy..

4)Its amazing at the number of folks who STRUGGLE to grasp this sensitive subject!!

5)Geez, backhand, forehand, knucklehand, knuckleheads for that matter. [Its not karate] If I was a woman I wouldnt let any of these novices examine me!!

 

[GodoShingo]

Dr. Robert Rey says the first part of the physical exam is to tell the patient how incredibly hot and sexy she is.

Dr. Tood Quinlan agrees and does a high-five.

 

[def jeff]

Dr. Robert Rey says the first part of the physical exam is to tell the patient how incredibly hot and sexy she is.

Nice. Personally, I'm more of a Dr. Sal Calabro kinda guy.

But Dr. Rey's suits are just Great! ... 👎

P.s. I'll paypal anyone who will wear cutoff scrubs to everyday of their anatomy course and have screen printed on the back "Plastics: Do Your Patients"

 

[indo]

Most women leave their bras on for exams even at the cardiologist. Just ask them to lift their breast for you or if they dont move it enough use the back of your hand to push it out of the way.

Here in Milwaukee, Wisconsin, the average breast is 75 lbs. Good luck lifting that bag of brats out of the way with 1 deltoid.