Agraphia Medical Tragicomedy


Tools of the Trade

So today we had our first physical exam class. Our instructor (a 4th year med student) was awesome, and basically gave us a tutorial over what are going to be our standard instruments over the rest of our lives. Always found in the "black bag" carried when making house calls, among other things.

Used for listening to stuff. Also, not limited to listening to heart sounds, as I have mistakenly thought in the past. Can obviously be used for cardiac purposes, but also for gut sounds, blood turbulence through arteries (in conjunction with a blood pressure cuff, allows you to take blood pressure), lung sounds... etc. etc. etc. One of the big challenges in any medicine is visualizing the problem- this can take the form of high-powered MRIs, CT scans, and X-rays... or can be just as simple as listening to a heart sound and diagnosing a murmur. This is why you see docs stereotypically walking around with stethoscopes around their necks. They're so damn versatile!
Reflex Hammer
We're supposed to move away from the familiar, triangular reflex hammers, and towards the newer, circular ones. The reason for this is that in order to diagnose the strength of the reflex (which, by the way, is what the doc is checking for when he smacks your knee- reflexes are a measure of how well your muscles are communicating with your brain, in a sense. If they are too strong or weak, its time for a neurology consult), you need to reliably test it with the same force every time. So, the new circular reflex hammers allow you to position the hammer at 45 degrees, drop, and observe. Same force, every time. Brilliant.
I've actually used this guy before. Essentially it's a high-powered light with a number of different heads attached to it. The heads allow you to magnify the inside of people's ears, focus on the retina of the eye, look in the back of someone's throat, etc. Obviously the insides of people's eyes are not particularly amenable to looking into without specialized instruments.
You'd best believe it. This will quickly become my indispensible best friend. In past years, medical students, residents, and attendings alike have walked around hospitals with white coats literally BULGING with books. Quick-diagnosis books, drug-interaction references, etc. etc. etc. There's no way to remember it all, and when you're in the room with a patient you can't very well have every textbook known to man, so there is an entire cottage industry built up around providing quick-reference tables that can be carried around.

The beautiful thing about the advent of the digital age is that most of these have been digitized. Instead of 10 reference books, you have one PDA. Quick, small, awesome. I'm kind of excited. Also, there are now ways to access patient records through electronic means, which means that many more things can be streamlined. Prescriptions can be checked against past drug allergies. They can also be electronically wired to Walgreens. I just need $400. Paypal box coming soon.

Nah, I'm just being cheesy. I've got no use for that.
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