i can't palpate stuff

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Dr McSteamy

Dr McSteamy

sh*tting in your backyard
10+ Year Member
15+ Year Member
i consider my palpation skillz weak.

i saw a pt today with splenomegaly, and i couldn't feel the borders. this wasn't a fat pt either.


does anyone else feel dumb like me?
 
Don't feel too bad. The enlarged spleen was probably first noticed on an imaging study anyway, and not through elite physical exam skills.
 
A tip I learned from one of my attendings is to use both hands, one on top of the other for palpation. However, only press with the hand that is on top therefore the nerve endings in the bottom hand are "only focused on sensation." I've been able to pick on 2 subtle abdominal masses that way. Hope this helps.
 
yeah, I couldn't feel the lump that the patient and the FP resident both felt.
 
Grover SA, Barkun AN, Sackett DL. Sackett DL and Rennie D, eds Does this patient have splenomegaly? J Amer Med Assoc. 1993; 270(18):2218-21, Nov 10.
 
technique and practise count for everything in palpation

make sure you use your finger tips (where the pulps are) - and NOT the side of the fingers as many 'senior' examiners will show (as in senior, i mean outdated and illogical). the fine touch and pressure sensitive receptors are in greatest density at the tips of your fingers, not on the sides.

practise on all sorts of objects, and get used to various shapes. if you're really really struggling to feel - you may have a neurological condition. otherwise, you could always make friends with the people down in the mortuary and say you want to palpate some organs. there you can press as hard as you like, and spend as long as you want. once you get a feel for how things should feel under your hands, you can start getting softer and softer, and then try it on alive people.

and finally, the most important rule of learning clinical medicine - whenever you see an interesting patient with your team, or on rounds.... ALWAYS go back and examine them fully - and dont just go back on your own. Take a friend. This is the most important advice -
 
i learned how to palpate towards the end of basic sciences.
they taught what you should do, ideally.

but i can't even palpate my own kidneys.
can you????

i guess some things you're not supposed to feel unless they're abnormally large.
 
Dr McSteamy said:
i learned how to palpate towards the end of basic sciences.
they taught what you should do, ideally.

but i can't even palpate my own kidneys.
can you????
Click to expand...

Don't even sweat it. You can't palpate stuff, I can't hear stuff. Ackowledge your limitations and find ways to work around it.
 
Dr McSteamy said:
i learned how to palpate towards the end of basic sciences.
they taught what you should do, ideally.

but i can't even palpate my own kidneys.
can you????

i guess some things you're not supposed to feel unless they're abnormally large.
Click to expand...

Yeah...I can't palpate my kidneys either (even with mad DO skillz). Maybe I should go on a diet. :laugh:
Just kidding. You don't ordinarily feel normal kidneys except in really skinny people. Hey, just keep palpating abdomens and eventually you will have a moment of inspiration. I remember how long it took me to palpate vertebral rotation... I really thought I would never get it but then eventually I learned to do it.
 
There's no reason to feel bad about PE skills this early in the game. Palpation isn't something you should just be able to do the first time. I'm a second year resident and I think my assessments have only recently become passable.

Like others have said, the problem is that most of us don't even know what "normal" should feel like. Most people don't go around palpating others' organs {inset obligatory dirty joke here} so there's no baseline for comparison.

Just don't lie about it. A third year on my team this year claimed he palpated the liver at 3.5 cm below the right costal margin. Amazingly the sono done the day before agreed. Such bull****.
 
Dr McSteamy said:
i consider my palpation skillz weak.

i saw a pt today with splenomegaly, and i couldn't feel the borders. this wasn't a fat pt either.


does anyone else feel dumb like me?
Click to expand...

Yeah, I feel dumb all the time. I think a lot of other people do too. During Med school you're supposed to learn this stuff but they act like you should come in already knowing. That's what third year is all about. You're not really there to learn- you're there to show off what you already know.
 
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