Will I struggle during 3rd year for ignoring Bates- Guide to Physical exam

[rodmichael82]

In my school they are teaching the pre-clinical courses (Pharm, Micro stuff like that) but we also have a course which is called Foundation of Clinical Medicine running throughout the year. We learn all the clinical aspect such as physical exams, taking a history etc.. We have assigned pages we are supposed to read every week from Bates- Guide to Physical Exam.

A lot of attendings have told me that out of the preclinical years the only thing that will carry on the most will be from this Clinical medicine course. I really have a hard time paying attention to these lectures, I suck at taking history, I suck at taking physical exams, I suck at review of systems.

Will this stuff really hurt me during 3rd year?

I just have too much stuff going on and even though I do have some extra time I don't feel like studying/reading Bates during my free time when I have Micro and other stuff hovering around especially boards.

What fields of medicine can I get into to avoid taking histories and doing physicals lol it's a really tedious process that I don't enjoy doing at all.

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[JP2740]

Hasn't hurt me so far.

But honestly how do you suck at doing review of systems? You can't ask someone if they've experienced something? How do you suck at H and P's. Follow the mnemonics until you know what you're doing, then the pertinent questions will add themselves as you get more experienced with problems.

Short answer: You're ok.

 

[rodmichael82]

Hasn't hurt me so far.

But honestly how do you suck at doing review of systems? You can't ask someone if they've experienced something? How do you suck at H and P's. Follow the mnemonics until you know what you're doing, then the pertinent questions will add themselves as you get more experienced with problems.

Short answer: You're ok.

I forget some of the details, in the review of systems I take a hell of a long time. Last week I had a patient on whom I did a HPI, PMH, FH, SH and ROS it took me about hour and half. The patient just kept talking and even then I forgot to ask some important details. Then when I was presenting to the attending I didn't do it the right way.

I just really hate taking history. I hope all of medicine doesn't revolve around this stuff. I can't imagine taking histories the rest of my life, I would kill myself

 

[JJMrK]

You'll get better. It's just a matter of doing it a bunch of times.

 

[slickster032]

Not at all.

 

[ED50]

At my school they assigned a big section of Bates and then just taught it to us in a 1-3 hour presentation. Just skip the reading and pay attention to those didatics. It's nice to know how to do a PE and a complete neuro exam before 3rd year but not essential.

 

[Ismet]

I forget some of the details, in the review of systems I take a hell of a long time. Last week I had a patient on whom I did a HPI, PMH, FH, SH and ROS it took me about hour and half. The patient just kept talking and even then I forgot to ask some important details. Then when I was presenting to the attending I didn't do it the right way.

I just really hate taking history. I hope all of medicine doesn't revolve around this stuff. I can't imagine taking histories the rest of my life, I would kill myself

I'm obviously not a 3rd year yet so this isn't in response to how Bates will help for 3rd year, this is just for the H&P. Like others said, the more you do it, the better you get. How many patients have you seen so far? Do you find yourself improving each time, even if it's only slight?

We started doing H&Ps on patients in February of MS1, and the first several times were definitely hard and took forever. Each week there were a lot of things I did wrong or forgot, but that's how you learn, and each week you get better. And unless your preceptor says you can't, I think it's perfectly fine to have a little "cheat sheet" of the things you commonly forget to ask, or just jot them down on your note sheet before seeing the patient. Soon you won't even need the reminders.

The H&P is very systematic. You need to come up with your own system and try to do it close to the same way every time so you minimize the things you forget. ROS is pretty easy - go head to toe - and it's relatively fast unless the patient has a wide variety of current ailments. I do the physical pretty much head to toe as well, not the random order we were taught in class. The same way each time so I don't forget to do anything. And as for reading Bates, we were assigned pages to read for our class too, but I never read them except for when I was on peds and realized that it's a whooooole different arsenal of questions and exam. But if a particular section of the H&P is giving you trouble, maybe reading that section of Bates will help.

 

[rodmichael82]

Well my school is very clinically oriented and they focus on this stuff a lot. We started learning the whole history taking thing first week of school and dealt with patients maybe the first month of M1. Then we had preceptor almost twice a month. I still have preceptor maybe twice a month but the thing is that I genuinely don't enjoy taking histories. Whenever I'm asked to do it, I tend to half ass it just to get it over with.
The whole history taking stuff is really boring to me. I don't know if that's a bad thing, you know non-medicine like?

I just really hope there's a field out there in medicine where I don't have to be taking histories all day every day.

 

[Ismet]

Well my school is very clinically oriented and they focus on this stuff a lot. We started learning the whole history taking thing first week of school and dealt with patients maybe the first month of M1. Then we had preceptor almost twice a month. I still have preceptor maybe twice a month but the thing is that I genuinely don't enjoy taking histories. Whenever I'm asked to do it, I tend to half ass it just to get it over with.
The whole history taking stuff is really boring to me. I don't know if that's a bad thing, you know non-medicine like?

That seems abrupt to start seeing patients in the first month of first year, do you think that was enough time to adequately learn the H&P before trying it on patients? We practiced weekly on 1-2 standardized patients for a couple months, and I think that was really helpful in cementing a system in my head.

Personally I enjoy talking to the patient/family when doing the history. I find the physical to be less exciting because I feel bad to be poking and prodding the patient for the umpteenth time that day just so I can learn and practice, but that's beside the point. Today I saw the same patient that my group-mate saw and presented to us 2 weeks ago, his condition had changed dramatically for the worse, and it was really interesting to talk through everything that has happened. I'm sure it's fine to think that taking histories is boring, and I don't think it means you're not a good fit for medicine or anything. What specialties are you possibly considering? Do you want one with a lot of patient interaction?

I just really hope there's a field out there in medicine where I don't have to be taking histories all day every day.

Surgery? Some of the histories I've seen from surgeons were like 2 sentences long

 

[Stixman28]

In every field, from surgery to pathology to medicine to radiology, you NEED to have the h and p to interpret a clinical situation appropriately. You'll get better at doing it faster and it won't seem as random.

For example, now when you're working on an hpi, you ask a **** ton of random questions cause you don't know a lot yet. Eventually, you'll be able to hone you're line of questioning to get pertinent positives and negatives while organizing a differential diagnosis in your head. It may sound like a far ways off but believe me, residency is just around the corner.

 

[rodmichael82]

That seems abrupt to start seeing patients in the first month of first year, do you think that was enough time to adequately learn the H&P before trying it on patients? We practiced weekly on 1-2 standardized patients for a couple months, and I think that was really helpful in cementing a system in my head.

Personally I enjoy talking to the patient/family when doing the history. I find the physical to be less exciting because I feel bad to be poking and prodding the patient for the umpteenth time that day just so I can learn and practice, but that's beside the point. Today I saw the same patient that my group-mate saw and presented to us 2 weeks ago, his condition had changed dramatically for the worse, and it was really interesting to talk through everything that has happened. I'm sure it's fine to think that taking histories is boring, and I don't think it means you're not a good fit for medicine or anything. What specialties are you possibly considering? Do you want one with a lot of patient interaction?



Surgery? Some of the histories I've seen from surgeons were like 2 sentences long

Sorry about the confusion I meant to say standardized patients initially and then we moved to real patients in Spring of M1.

 

[VisionaryTics]

I think you should focus on your physical examination skills and then just be systematic with your H&Ps. Your H&Ps will get better as you do them. But you can't improve your physical examination skills if you don't know how to do anything. Practice a multisystem neuro exam, learn how to examine joints, look in ears and mouths routinely, etc. That will help you a ton as you go into M3 and beyond.

 

[Bacchus]

Depending on your future specialty (which you don't know yet) I'd put a lot of merit into the HPI. It's much easier to document a thorough HPI/ROS than a physical exam (and not commit fraud by just clicking normal findings) and you need to do this to increase your billability (don't know where this word came from 😛) level. A lot of the FM docs that I'm training under do a fairly thorough PE, but they get their level 4 and 5s in terms of billing usually from HPI/ROS and A/P.

 

[obgyny]

I just really hope there's a field out there in medicine where I don't have to be taking histories all day every day.

Radiology?

You're going to be doing so many H&P's in 3rd year (on every rotation), you'll be able to do it in your sleep.

No you don't have to read bates. You just have to get a routine down. Make your own template (CC, HPI, PMH, PSHx, ROS etc) with all the questions you should ask. Re-write this template down several times to start memorizing it. Always go in the same order every time you do it, that way you won't miss anything. As you go further through 2nd and 3rd year, you'll get better at knowing what stuff is pertinent and what additional questions to ask.

As for ROS, just go from head to toe and ask questions about each system: General, HEENT, CV, lungs, GI, GU, MSK, etc.

Same goes for physical exam. Write down all the things you want to check and do it in the same order every time (I tend to go head to toe). Later on, you'll be able to better choose what specific things to look for.

We're all terrible at it in the beginning, it just takes practice.

 

[DrBodacious]

The thing that will "carry the most" is Step I... In the match. I wouldn't sacrifice basic science studying with the idea that you will be a better clinician by reading bates cover to cover. Obviously do what you need to do to make the grade in you clinical intro class, but you will learn how to do an H&P eventually . You could probably focus on your H&P skills for a week before MS3 starts and be more than fine.