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Sr.Lect. Dr. Anca Negovan

• With the patient- interwiew, history taking/listen, talk,
assessment understanding
• With medical staff- medical language, terminology
• Comprehensive examination-learn and practice it under
• clinical reasoning, thinking, judgment
• Writing a medical report
• how to be part of a health care team
• There has been a significant change in the way
healthcare workers interact with patients:
from “biomedical” model (disease
management) to patient-centered model
(address and treat the whole patient,
decision-making is shared
• Doctor-patient communication is the “corner-
stone” of this new model
• Becoming a good communicator is the
demanding objective for medical students
• Cultural background and tradition may have a
large influence on disease management (belief
about the origin of disease, prejudice, stigma)
• Teaching the foreign students to conduct a
medical interview is a challenging issue for
medical semiology classes in the 3rd year
• “The rules is: there are not rules”
The keys of good communication
• The ability to judge the situation and pull the
appropriate phrase, word, or action from
internal catalogue
Foreign students in the hospital
• Different appearance of foreign students
• Three different languages
• Difficulties:
– First time at bedside of the patients
– Acceptance of the student/patients
– Finding an interpreter
– Guide the interview
– Writing and presenting case report
– Watching many cases, doctors at work
• You will need to learn how to gather
information from the patients, analyze and
sintethyse them, in order to be able to extract
from a mass of SYMPTOMS and SIGNS those
that are of crucial significance for the
diagnosis and treatment.
• Patients are first of all humans with fears and
hopes, seeking relief, help and reassurance.
• So be:
– Tactful
– Sympathetic
– Understanding
• let your own individuality interact with the
individuality of the patient
• in all cases and circumstances respect the
personality of the patient who places himself in
your hands
• Don’t ever forget to be humble.
• Learn to use and trust your senses: your eyes
to see, your ears to hear, your hands to feel
and your heart to feel compassion.
• To have theoretical knowledge of symptoms
and signs /to know them and to recognize
• To be able to communicate with the patient
and to examine him from head to toe.
• Never lose your common sense which is a
solid ground for medical reasoning, one of the
key elements of medical practice.
• Medicine is the study of the manifestations of
disease in its sufferers (patients) so that one may
attempt to diagnose, attempt to treat but always
to care
• No two patients with the same disease will give
identical manifestations
• The narratives of what they feel (symptoms) will
differ, and what is found on examination (signs)
will vary
• This great variation can be learned only from the
one true teacher of disease that the student of
medicine encounters – the patient.
• And it is a lifetime’s work
The goals of the physical examination
• to learn the techniques of the
physical examination
• to practice these techniques in
the setting of a normal physical
• to develop an orderly approach to
performing a complete physical
• to begin to differentiate between
a screening physical examination
and a more focused examination,
and when each type of
examination is indicated
• to understand how to use
instruments, including a
Being important…

 To understand the underlying anatomy and

physiology of the normal physical
 To be able to perform a complete screening
physical examination in a logical fashion
with minimal discomfort to the patient.
 To be able to recognize normal findings on
the physical examination
Basic Clinical Skills
Years ago:
• 70% of diagnosis can be based on history alone
• 90% of diagnosis can be made when the physical
examination is added
• Expensive tests often confirm what is found in the
• To sustain a diagnosis a combination of criteria are
needed: history details, clinical examination and
investigation findings specified usually in guidelines
Physical Examination
• Knowledge Base • Perceptual Skills
– Sensory
• Technical Skills • Interpretation
– Exam skills • Communication Skills
– Use of equipment • Interpersonal Skills

 Normal examination
 Anatomy
 Physiology
 Techniques
 Equipment
 Expected normal findings
 Normal variations
 Changes with age
 Extrapolation to common abnormalities
Learning the Physical Examination
• A key to a thorough and accurate physical
examination is developing a systematic
sequence of examination
Learning the Physical Examination
• An important goal is to minimize the number
of times you ask the patient to change
• Being a medical student in the current era can be
overwhelming: information overloads us from every
• The need for a solid foundation in a methodical and
systematic approach to medicine has never been
• A straightforward and hopefully easy way to teach you
not what to think, but rather how to think.
• The systems are a guide, and become valuable only
after dedicated application of the principles - in study,
and particularly at the bedside.
The Card System of the Diseases
1. The Definition 6. Investigations
2. Epidemiology
7. Management
3. Aetiology

4. Biological Behaviour 8.

5. Clinical Manifestations

=the narratives of what a patient feels

= relate what is found on clinical examination
• Obtained on: inspection, palpation, percussion
and auscultation.
• Remember, that signs may also occur locally,
at distance, systemically, or in endocrine ways.
• Attendance
• Participation
• Honesty
• Feedback
• Attitude