This book has been written with an eye towards both clinical diagnosis in actual patient management, as well as clinical diagnosis in your own practical exam settings. It represents a departure from the usual physical examination 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 & how it applies to the actual patient. By approaching clinical surgery in a pragmatic & demystified fashion, the significance of the material should be readily apparent & the underlying principles more clearly understood. Format of this book Topics of the modules are carefully selected according the needs of undergraduate surgical students & postgraduate general surgery trainees. In particular each module is written to answer the question: "What do I really need to know about this area of patient disease?" 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. Important & relevant points in history taking are given in each module with an emphasis to formulate a working diagnosis before clinical examination. Clinical examination techniques are described in step-by-step detail, with aids of photographs. Special maneuvers that are frequently utilized or asked in viva examination are also described. The rationale for each aspect of the examination is addressed &, where appropriate, relevant pathophysiology discussed. In general, students identify their role in patient care either by trial & error, or through the beneficence of more senior students, residents or consultants. This is not particularly efficient & diminishes the potential for learning & fun. Colored photographs, as well as illustrations, clearly identifying appropriate clinical techniques are given including a lot of gross clinical photographs. I hope that this book helps you to master the art of history taking & clinical examination, both for the benefit of your patients & for your excellence in the profession. As the skills required of a surgeon/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 & alert you to the fact that there are often many ways of achieving the same end (ie 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 & 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 & 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 & value of what you can uncover with a sharp mind, agile fingers & a few simple tools!
1 The techniques of physical examination and history taking that you are about to learn embody time-honored skills of healing and patient care. Your ability to gather a sensitive and nuanced history and to perform a thorough and accurate examination deepens your patient relationships, focuses your patient assessment, and sets the direction of your clinical thinking. The quality of your history and physical examination governs your next steps with the patient and guides your choices from the initially bewildering array of secondary testing and technology. Over the course of becoming an accomplished clinician, you will polish these important relational and clinical skills for a lifetime. As you enter the realm of patient assessment, you begin integrating the essential elements of clinical care: empathic listening; the ability to interview patients of all ages, moods, and backgrounds; the techniques for examining the different body systems; and, finally, the process of clinical reasoning. Your experience with history taking and physical examination will grow and expand, and the steps of clinical reasoning will soon begin with the first moments of the patient encounter: identifying problem symptoms and abnormal findings ; linking findings to an underlying process of pathophysiology or psycho-pathology; and establishing and testing a set of explanatory hypotheses. Working through these steps will reveal the multifaceted profile of the patient before you. Paradoxically, the very skills that allow you to assess all patients also shape the image of the unique human being entrusted to your care. Clinical Assessment: The Road Ahead This chapter provides a road map to clinical proficiency in three critical areas: the health history, the physical examination, and the written record, or " write-up. " It describes the components of the health history and how to organize the patient's story; it gives an approach and overview to the physical examination and suggests a sequence for ensuring patient comfort; and, finally, it provides an example of the written record, showing documentation of findings from a sample patient history and physical examination. By studying the subsequent chapters of the book and perfecting the skills of examination and history taking described, you will cross into the world of patient assessment— gradually at first, but then with growing satisfaction and expertise.
As you read about successful interviewing, you will first learn the elements of the Comprehensive Health History. For adults, the comprehensive history includes Identifying Data and Source of the History, Chief Complaint(s), Present Illness, Past History, Family History, Personal and Social History, and Review of Systems. As you talk with the patient, you must learn to elicit and organize all of these elements of the patient’s health. Bear in mind that during the interview this information will not spring forth in this order! However, you will quickly learn to identify where to fit in the different aspects of the patient’s story. As you gain experience assessing patients in different settings, you will find that new patients in the office or in the hospital merit a comprehensive health history; however, in many situations a more flexible focused, or problemoriented, interview may be appropriate. Like a tailor fitting a special garment, you will adapt the scope of the health history to a number of factors: the patient’s concerns and problems; your goals for assessment; the clinical setting (inpatient or outpatient; specialty or primary care); and the amount of time available. Knowing the content and relevance of all components of the comprehensive health history allows you to choose those elements that will be most helpful for addressing patient concerns in different contexts.NAIL CARE LEARNING MODULE.pdf No School AA 1Manicure nail Nail care livelihood education Nail Care Tools and Equipment NAIL CARE LEARNING MODULE.pdf 122
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