NSG 6020 W6 Physical Exam Video and Write Up Assignment
NSG 6020 W6 Physical Exam Video and Write Up Assignment
Complete Health History and Physical Assessment Write-Up
Presentation
This assignment consists of complete head to toe physical
while being videoed. You will also need to complete a written assignment of
your findings. Review the Expanded
rubric to note how you will be graded on this assignment.
Taking a careful and complete history and performing a thorough physical examination are hallmarks of the good internist and one of the distinguishing characteristics of a master clinician. The initial visit sets the tone of the immediate and future relationship with the patient and begins the process of diagnosing and managing the illness; it is a dynamic encounter, with each of the patient’s responses stimulating further probing and forming of diagnostic hypotheses. The physician must be attentive to the patient’s story, piecing together each bit of evidence to form a tentative preliminary diagnosis and differential diagnoses.
Nothing should escape the eyes and ears of a watchful diagnostician. History taking is more than information gathering: it affords the opportunity to decipher the patient’s body language as the inquiry proceeds. At this stage, no symptom or circumstance should be disregarded. With an understanding of biology and medicine coupled with past experience, the physician tries to connect the salient parts of the patient’s story to develop a plausible explanation of the physiologic or pathologic events that lead to illness.
Although striving for a single diagnosis, the physician should realize that more than one disease may be present and that rare diseases are diagnosed only by those who consider them. Nevertheless, the maxim “uncommon presentations of common diseases are more frequent than common presentations of uncommon diseases” is likely to be true. It is important to continue both to gather information and to be open to reforming the diagnostic hypothesis as more information becomes available. Premature judgment or the failure to continue considering reasonable alternatives after an initial diagnosis is made is the single most common diagnostic error.1, 2 In the field of decision science, these failures are postulated to arise from “cognitive dispositions to respond” and include several of the biases in judgment or reasoning defined in Table 16-1 .3 It is hypothesized that a greater awareness of these prejudices among clinicians may facilitate “cognitive debiasing,” thereby reducing the frequency of these common errors of reasoning.4 An alternative or potential complementary approach is to use decision-support software to expand the differential diagnosis and avoid overlooking unusual or severe conditions.