ソース:先週 S Talwalkar、モルドバ、内科・小児科、エール大学医学部、ニューヘブン、CT
観察、検査、身体検査の基本である、患者との接触の最初のポイントから始まります。観察と検査が同じ意味で用い観察は慎重に使用する情報を得るために 1 つの感覚を指す一般的な用語。検査は、1 つの視覚的に観察することが、行動ではなく、体の表面の所見には通常、身体検査に言及するときに限られた行為です。熟練した臨床医は、主に患者、ビジョン、タッチ (パーカッション、触診) に頼ると聞いて (打診と聴診) の把握を支援するために彼らの感覚すべてを利用します。匂いも (例えば、個人の衛生状態、物質使用、または代謝性疾患) 患者の遭遇の間に重要な診断情報を提供できます。幸いなことに好みの感覚はその糖尿病は尿の甘い味で多くの世紀の診断された注意してくださいに興味深いものであるが、医学では、主として歴史的遺物であります。体験では、臨床医はのみ得られる臨床スキルの意図的な実践を通して患者の何千もの長年にわたって重要なシックス センス – 本能 – を開発します。臨床医の本能は、主にベッドサイドの観測に基づいて、深刻な病気の強力な予測する示されています。このビデオおよび臨床スキルのビデオ コレクションの他は、この習得のレベルを学習するための方法の手順です。
Observation is an important component of the patient encounter that begins at the first point of contact with the patient. Observation relates to information gained by using one’s senses during the examination and encompasses physical findings as well as behavioral, situational, and ancillary observations. A specific set of observations makes up the general survey, which should be a part of every patient encounter. Additional observations occur during each organ-specific part of the physical examination, with inspection accounting for the bulk of the skin examination. In addition to direct observations of the patient, astute clinicians attend to information in the patient’s surroundings and social relationships, as well as the feelings that patients may evoke in them, as part of good patient care.
Observation and inspection are fundamental to any clinical examination. General observations begin at the first point of contact with any patient and continue throughout the clinical encounter, even while just having a conversation with the patient. Inspection is more goal-directed and it is limited to what one can observe visually while examining specific body parts like skin, eyes or ears, sometimes with the help of a specialized equipment.
Here, we illustrate the general observations that a clinical should consider performing during each clinical encounter, followed by a few considerations related to the visual inspection steps.
First, let’s go over some general observation steps that a clinician should keep in mind when meeting with any patient. These observations can be made anytime during the examination.
During the initial conversation when a patient is explaining their illness, note the state of their physical health and ask yourself “Is the patient’s appearance consistent with the stated age? Does the patient appear fit and healthy or weak and frail? Is the patient awake and alert, or somnolent?” Simultaneously, gauge their mental status and affect, and examine whether their thoughts are organized.
During the conversation, a physician can also evaluate the patient’s thought content and perceptions. In addition, look for signs of emotional distress like excessive fidgeting or inadequate eye contact. Also, pay attention to the way you are feeling in the presence of the patient, as this may prove diagnostically useful. An uncharacteristic feeling of sadness in the clinician may lead to considering a diagnosis of major depressive disorder. Furthermore, during the conversation, observe for signs of pain by looking at facial expressions, and by noting if the patient is exhibiting guarded movements or autonomic signs like diaphoresis. Also, note the patient’s hygiene, clothing, make up, etc. for additional clues that might help in diagnosis. In addition, look for signs of respiratory distress. Note whether the patient speaks in complete sentences without any difficulty. Observe if the patient is “tripoding”, which is leaning forward with the arms supported. Notice if visible accessory muscles of respiration are being used, which is common in cases of respiratory distress.
Taken together, these simple observations can provide substantial insight into the patient’s physical and mental status, and can help in diagnosis of their illness.
Now that you know about general observations, let’s look at inspection, which is critical to comprehensive and organ-specific physical examination.
First, explain the patient the purpose of inspection and obtain their consent. As mentioned earlier, this involves visually observing body surfaces to check for any abnormalities. During a comprehensive skin exam, inspection of all anterior, lateral, and posterior body surfaces and mucous membranes is necessary. Note the color of the skin or mucosa at each site examined. Common findings include areas of hypo- or hyper-pigmentation, pallor, cyanosis, jaundice. Also, check for the degree of hydration, turgor, and texture.
Mostly inspection involves keenly looking at different regions of the body surface with naked eye. Sometimes, special equipment is required for inspection of the structures inaccessible to the naked eye. For example, an otoscope is necessary for the inspection of tympanic membranes. Some areas of the body require inspection with manipulation. Like, for scalp examination, a physician may have to manipulate through the patient’s hair to expose the surface. Note the inspection results for each site examined, which can be combined with observations and patient’s history to predict the illness. At the end of every exam, thank the patient for their cooperation.
You have just watched JoVE’s video on general observations and inspection during a patient encounter.
Taken together, observation and inspection skills play a critical role in clinical diagnosis. Here, we reviewed a specific set of observations that should be a part of every clinical encounter. Additionally, we discussed inspection, which is an important aspect of any physical exam and can assist in bedside diagnosis. As always, thanks for watching!
