An efficient approach to the comprehensive exam

In Immersion, you learned a ‘head to toe’ approach to the basic physical exam, which you successfully demonstrated for your Immersion PE final.  As you practice the comprehensive exam with a hospitalized patient, you may want to adapt your approach to maximize efficiency for a person in bed. In this chapter, you’ll see a 15-minute PE that incorporates all of the elements you learned in Immersion, organized by Dr. Som Mookherjee to minimize position changes for a hospitalized patient.

This patient is able to sit up in bed, so after measuring vital signs, Dr. Mookherjee asks him to sit on the edge of the bed and performs all of the exam sections that are best done seated – head and neck, neuromuscular and chest exams. The patient then lies down for the cardiac and abdominal exams.  If the patient were unable to sit at the edge of the bed, Dr. Mookherjee performs the exam in a similar order, modifying as needed for the supine position.

You will see that he integrates cranial nerve testing into the head and neck exam, checks the foot pulses when he kneels to check the Achilles reflex, and palpates and auscultates carotid pulses after auscultating the heart. The organizing principle of this approach to the PE is efficiency, eliminating unnecessary position changes or circling back for both you and your patient.

Review this checklist, watch the example, then try it out yourself the next time you are in the hospital.