4 Chapters
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Part Four

Rowley, Nic Aeon Books ePub


With practice, it should be possible to examine any of the systems described in Part 2 in about five minutes each. If you find you are taking significantly longer than this, you are either trying too hard or not practising enough.

However, it is often useful to combine the important elements from all the systems examination procedures into a quick, basic screening examination that can be performed in under 15 minutes.


• Be kind

• Be gentle but palpate firmly and confidently

• Explain what you are doing

• Try to examine with warm hands

• Do not subject the patient to unnecessary changes of posture

• Be mindful of modesty but remember that examining an area that is not adequately exposed is often worse than not examining it at all

• Hurry slowly

• When interpreting your findings, on the whole trust your first impressions

• Do not sit on the fence

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Part Two – Basic Examination Procedures

Rowley, Nic Aeon Books ePub


Hands on aims to help you get the most out of your practical clinical training by encouraging you to develop quick, logical and useable clinical examination routines.

Each of the following six sections starts with a brief summary of the examination routine for the system involved. This is followed by pages containing photographs of certain steps being applied in practice with hints and tips on how to perform the techniques illustrated. Each section ends with a summary of how the information obtained should be recorded in the notes.

The emphasis throughout is on the description of the various examination techniques. Information concerning the detailed interpretation of particular clinical findings should be sought in textbooks of general medicine.

However, I strongly suggest that you do not spend too much time reading about the significance of abnormal physical signs until you can perform the routines outlined in Part Two almost without thinking. Once your hands have learnt what to do, your mind will be released to think about what you are discovering. You will then be in a better position to consider the diagnostic significance of your findings.

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Part One – History Taking

Rowley, Nic Aeon Books ePub


First attempts at history taking are often thwarted by the desperate effort to remember what questions to ask in what order. Every practitioner knows the sinking feeling engendered by a blank mind (something which Zen aspirants may take years to achieve…); and yet an experienced practitioner often seems able to elicit reams of relevant information whilst hardly seeming to ask any questions at all.

This is not as difficult to do as it may seem.

The first trick is to understand what you are really trying to find out, i.e.:

• What has happened?

• To what kind of person?

• Why are they asking for help now?

• How is the problem affecting the person and their family?

• What sort of physical and social environment does the person come from?

• Do any of the complaints suggest the diagnosis of a ‘disease’?

The second trick is not to ask too many questions. Let your client tell their own story in their own way.

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Part Three – Topics of Special Interest

Rowley, Nic Aeon Books ePub


Examining Lumps

Examining lumps is an important part of primary care and the statement ‘I've had this thing here for a few days/weeks/months/years and I was just wondering whether it was anything to worry about’ is familiar to all practitioners. Often, the subtext is ‘do you think this lump is cancerous?’.

You will already have learnt that malignant lumps are usually distinguishable from their benign cousins by rapid growth, irregular shape, hard texture, fixity to surrounding tissue and a tendency to produce systemic disturbance such as malaise and weight loss. Malignant growths also tend to spread to other sites, e.g. bone and liver.

However, when confronted with a lump in the clinical situation, the tendency is to look at it, poke it a bit and still wonder what it is; so a systematic approach is needed to make sure that malignant lumps are not missed, that inflammatory lumps are distinguished from neoplastic lumps and that all lumps are managed appropriately.

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