Monday, April 27, 2009
The dying art of physical exam
I got called about an older lady to evaluate for a possible bowel obstruction. When I saw her, she looked fine. She denied nausea or abdominal pain. She was hungry. She'd been in the hospital for over a week, recovering from dehydration and a bad bout of pneumonia. On exam felt an obvious large, soft, mobile mass in the left lower quadrant. So I got a CT scan, seen above.
She'd been in the hospital for over a week. I was the fifth and latest consultant on the case. Reading through the chart, I kept seeing the same description of the abdominal exam in the progress notes of the various doctors involved: soft, non-tender, non-distended. This thing ended up being a complex ovarian neoplasm.
(Responses along the lines of "I've had surgeons who miss obvious cardiac murmurs/pulmonary edema/want to take a gallbladder out of a patient who just had a stroke" are appreciated and welcomed. We all miss things. Talking about it makes us better, right?)