Secrets of general practice – the quick examination
We all know that time is limited in general practice. One of the keys to managing the stress of the short consultation is to get really slick and efficient when examining patients.
The old system of learning how to examine patients was a haphazard and variable experience. Medicine has long been pervaded with a ‘see one, do one, teach one’ mentality of learning on the job and it was utterly dire. While there are plenty of the old and bold out there who will grumble at the modern medical curriculum I will happily defend the practice of systematically teaching clinical examination skills to students from day 1.
The students learn long and complete versions of the examination – however, they then struggle to adapt them to the time pressures of general practice. Abbreviated examinations are completely critical for general practice so we should acknowledge it and expressly teach the skills. The one above, plummy neurologist aside, is a great example.
Curiously, GPs often recognise the need to improve on communication skills but I’ve never done an appraisal with a GP who thought they needed to enhance their examination skills. I have met plenty who struggle with their ‘time-management’ (a GP euphemism for persistently running late). Perhaps it’s a sign of modern medical practice where examination has now been devalued but I feel there is still scope, even for experienced GPs, to refresh and to hone these fundamental skills.
