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A Practical Guide to Clinical Medicine

A comprehensive physical examination and clinical education site for medical students and other health care professionals

Web Site Design by Jan Thompson, Program Representative, UCSD School of Medicine.
Content and Photographs by Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California 92093-0611.
Send Comments to: Charlie Goldberg, M.D.

Introduction Breast Exam Write Ups
History of Present Illness Male Genital/Rectal Exam The Oral Presentation
The Rest of the History The Upper Extremities Outpatient Clinics
Review of Systems The Lower Extremities Inpatient Medicine
Vital Signs Musculo-Skeletal Exam Clinical Decision Making
The Eye Exam The Mental Status Exam Physical Exam Lecture Series
Head and Neck Exam The Neurological Exam A Few Thoughts
The Lung Exam Putting It All Together Commonly Used Abbreviations
Cardiovascular Exam Medical Links References
Exam of the Abdomen    

The "daVinci Anatomy Icon" denotes a link to related gross anatomy pictures. DaVinci's Anatomy Symbol

Introduction

This guide has been assembled with an eye towards clinical relevance. It represents a departure from the usual physical exam teaching tools which, in their attempts to be all inclusive, tend to de-emphasize the practical nature of patient care. As a result, students frequently have difficulty identifying what information is truly relevant, why it's important and how it applies to the actual patient. By approaching clinical medicine in a pragmatic and demystified fashion, the significance of the material should be readily apparent and the underlying principles more clearly understood. In particular:

  1. Each section is constructed to answer the question: "What do I really need to know about this area of medical care?" The material covered is presented in a concise, ordered fashion that should be readily applicable to the common clinical scenarios that you will actually see in day to day practice. Esoterica has been purposely excluded.
  2. The Web-Based format allows for easy access to information and provides integration of text, pictures, and sound.
  3. Exam techniques are described in step-by-step detail. Special maneuvers that are frequently utilized are also described.
  4. The rationale for each aspect of the examination is addressed and, where appropriate, relevant pathophysiology discussed.
  5. Detailed descriptions of how to function in clinical settings are included. In general, students identify their role in patient care either by trial and error or through the beneficence of more advanced students, residents or staff. This is not particularly efficient and diminishes the potential for learning and fun. The following sections are included to specifically address this issue:
    1. Oral presentations
    2. Patient write-ups
    3. Working in outpatient clinics
    4. Functioning on an inpatient service
    5. Clinical decision making
  6. Pictures clearly identifying appropriate techniques accompany each section. Examples of common pathologic findings are included as well.
  7. Images of gross anatomic correlates (denoted by the "daVinci Icon" shown above) are incorporated within a number of the segments.
  8. Video clips of selected examination maneuvers and findings.
  9. Carefully selected links to other useful websites are available.

I hope that this site helps to make the educational process both fun and rewarding. As the skills required of a physician cannot be learned from any single source, I encourage you to make use of as many other references as possible. This should reinforce basic principles and alert you to the fact that there are often many ways of achieving the same end (i.e. there is frequently no single right way of doing something). What follows, then, serves merely as an introduction. I have tried to capture those core behaviors that define clinical excellence and will have prolonged applicability, even in a technology driven world. The learning process continues (I hope) until the day you stop practicing medicine. There are always new techniques to learn and unusual findings to incorporate into your personal libraries of medical experience. However, unless you take the time to build a solid foundation, you will never have confidence in the accuracy and value of what you can uncover with a sharp mind, agile fingers and a few simple tools!

Please Note: Medical and non medical practitioners are welcome to use this site for learning purposes. However, it is not meant as a substitute for appropriate evaluation of medical conditions or pursuit of an advanced education through traditional mechanisms. While the authors welcome feedback and comments, please do not solicit medical advice.

This site is, and will always remain, a work in progress. I look forward to receiving any and all comments/suggestions/feedback (use the link to my e-mail, located at the top of each page).

Charlie Goldberg, M.D.
University of California, San Diego School of Medicine
San Diego VA Medical Center

Jan Thompson

University of California, San Diego School of Medicine
San Diego, CA


September, 2004

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