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The Physical Exam
Posted 06:01 PM, October 11, 2008, by nmahmudThis week we were asked to perform a physical exam of sorts on a well-behaved but skeptical horse. I was handed my stethoscope and, draping it around my neck so as not to appear too single-minded, I approached my patient. He allowed me to place my hands along his neck, and I began to stroke gently in an effort to build rapport with my patient. I was intently focused on his ears, looking for a sign that he was relaxed and comfortable with me. But after nearly a minute, his ears remained pinned back- a sign of wariness. I did not know what more I could do, so I slipped on my stethoscope and placed the diaphragm behind the elbow of his left forearm. What struck me most was how uncomfortable I was listening for a heartbeat while knowing that my patient was not at ease. Herein was a valuable if subtle lesson. Establishing a good rapport is remarkably important, as it puts both the patient and doctor at ease. However, one way or another, a doctor needs to get the necessary information from the patient. This may entail a certain level of discomfort on the part of the patient, physician, or both.
Comments
Comment by: Lisa Wheeler, MS Ed, PA-C at October 13, 2008 07:36 AM
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Congratulations on your physical exam experience. So, I've been in medicine for almost 20 years, and I am always amazed at the energy that patients display and my own energy. How much of our (practitioner) energy is a reflection of the energy around us or our internal energy? More clearly, what was the non-verbal energy and/or message you were projecting that the horse picked up on? When the horse had his ears back was that an invitation to move forward or an invitation of back off? I'll invite you to consider an "approach and retreat" technique for not only the horse, but all your patience. Ask permission and at any point you feel like you don't have permission stop. When permission is granted again move ahead.
Remember it is not about the horse as much as it is about you and your message and intention. But in that same breath, you have to be clear on your patients energy (fear, anxiety, etc.) The horse is providing you unbiased feedback.
Trust me, this is real life. It doesn't matter if the patient has 2 or 4 legs.
Congrats on this experience and good luck!
Lisa