A list of 10 clinical pearls about the physical exam that will help you be a more effective intern, and deliver better patient care.

I know that some of these (e.g. tailor your exam to why the patient is in the hospital, don't shortchange exams on patients with disabilities) seem obvious, but I see these concepts forgotten or ignored all of the time. If I had a dime for every progress note whose exam was verbatim: "Chest - CTAB; Heart - RRR, nl S1 S2, no m/r/g; Abd - Soft, NT, ND, normal BS; Extremities - No c/c/e; Neuro - AAOx3, non-focal" irrespective of whether the patient was admitted for a stroke, arrhythmia, or bowel perforation...

A few references:

The lack of hypotension in the majority of patients with pericardial tamponade: https://jamanetwork.com/journals/jama/article-abstract/206803

The uselessness of auscultation of bowel sounds:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566372/
https://blogs.jwatch.org/frontlines-clinical-medicine/2017/03/01/listening-bowel-sounds-outdated-practice/

Tips and exam strategies for patients with physical or cognitive disabilities:
https://wordpress.uchospitals.edu/transitioncare/files/2012/05/Kalichman.ExamStrategies.pdf
https://www.mountsinai.org/about/diversity/disabilities/physical-sensory-disabilities

A wonderful, general resource for learning more about the physical exam:
https://stanfordmedicine25.stanford.edu/


The video thumbnail incorporated a picture of a reflex hammer provided by user MacSeagull under CC BY SA 4.0 and downloaded from Wikimedia Commons July 2019.