:: Scoping the heart November 14, 2007Posted by Minci 先生 in Medical School.
Each medical student will eventually develop their own style in examining a patient. Most often it will be influenced by the consultant or other doctors in the team that they’ve been attached to, videos they’ve watched and a rare few, would just figure out what’s best for them and their patient all by themselves.
My first introduction with ‘style development’ was when I was taught the ‘scratch test’ in detecting hepatomegaly and splenomegaly (big liver and spleen).
The second was on how to examine the knee upon discovering how my physical limitations (strength & stature) could result in a less convincing result if not done right.
There were a few ‘style development lessons’ afterwards including on how to communicate with colleagues and patients. The most recent technique I’ve learnt for the benefit of myself is on how to listen for the heart on a woman’s chest.
Women have breast. (Ada yang tak tahu lagi ker?) And I’ve witnessed a few ways as to how a doctor may move the breast out of the way in enabling themselves to place the stethoscope well on the chest. These ways are not wrong, they just look a bit funny sometimes. So some people would; (with the patient lying down)
Just push and slide the stethoscope under the breast. rodoklah sampai dapat, matilah kalau breast besar. I used to do this. 😛
Examining from the right side of the bed , lift the breast with one hand gaya angkat kucing atau pilih ikan di pasar, put the stethoscope on the chest and then tutup stethoscope with the breast again.
From my observation, Way 1 is quite popular but then I discovered a very slick method of ‘pushing the breast out of the way on Youtube and has used that technique ever since. I can’t find it now but you do it by either asking the patient to lift it up for you OR you pushing it up by using the back of the hand allowing the piece to be placed just in front of it.
Then there is a question of ‘where you put your eyes’. One needs to concentrate as they listen to the very soft, almost inaudible heart sounds. To do this, some doctors/students have the habit of;
Having their head bowed so close to the chest as though it would make a difference if their head were much higher.
Stare and stare and stare and stare blankly at the patient’s chest. memang takde nafsu whatsoever but still.. it is kind of awkward.
Stare and stare and stare at the patients face while smiling like a pervert.
Haha.. wanna know my style? Rahsia.