Agraphia Medical Tragicomedy



I practiced a regular physical exam yesterday (as I've mentioned before, there are several specialty exams - heart, lungs, knee, etc - but this was vanilla head-to-toe). One of the things that they've pounded into our heads is that keeping the patient comfortable is really important. There are all sorts of complicated draping methods you can do with sheets to *ahem* keep certain body parts covered while still allowing access to others, if you catch my drift.

The woman that I was examining has been doing this for 33 years, and apparently even used to go on lecture circuits about how to properly examine a patient. She was sitting in a patient gown as I walked in the room. I made a little chit-chat, washed my hands (key!), and then got down to the examination.

As I neared the cardiac part of the exam (which you do entirely from the front) I started wondering how I was going to "preserve her modesty" while still listening to her heart. It's essentially impossible to listen for cardiac problems through any sort of fabric - your stethoscope needs to be touching skin. Apparently I didn't have to worry. At the slightest hint that I was going to need to listen to her chest, she reached back, and in one swift motion, dropped the entire gown to her waist.

Now, I will say that the cardiac exam was one hell of a lot easier without having to worry about patient comfort. She obviously didn't mind at all (and I suppose it says something for medical school desensitization that I wasn't uncomfortable myself), but she's a unique case. What happens when I'm not dealing with someone who has been doing this for 30-odd years?

Anyhow, there's my first brush with patient nudity. It was easy this time, but I think she had a lot to do with it. Any advice?

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  1. Hi – found your site from lizdoessydney’s blog…
    The way I do a cardio exam on a modest female is to lay a towel across her lap, then reach up from the bottom of the gown (which can be difficult when she’s seated rather than supine). Although I’ve had my share of ‘happy to be examined’ people in my time too… :)

  2. I find that it gets easier with time. My first male genital exposure was sort of traumatizing, but it’s gotten a lot easier since then… you know, as i continually have to lift breasts out of the way to palpate/ausciltate the apex beat/mitral valve. Also, i find that patients in the hospital are a lot more willing to get naked than are clinic patients, and ambulatory care patients.
    Keep Truckin’ Zac!

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