The Logical Flow of a Physical Exam

The other day I was observing a 2nd year medical student examining a patient in my outpatient clinic. The student did a very good job- doing a very thorough examination of each organ system.

The only problem was the flow of the exam or the lack of one. He would start at the head and examine the mouth and then move down to the neck. Later he would come back to the mouth to check for the midline tongue and the gag reflex.

The patient would have to lie down for the abdominal exam, and then sit up to have the lumbar spine examined; lie down for the Straight Leg Raise test and sit up for the knee and ankle jerk; you get the idea.

It seemed an example of a logical flow of a physical exam that combined the elements of:

1. Going down from head to toe
2. Patient comfort and convenience
3. Efficiency

might be helpful. Of course everyone will have a slightly different protocol for doing this.

As I was wondering how to present this information, I came across Bubbl.us a cool mindmapping tool. So I created the following schema of the Logical Flow of a Physical Exam using Bubbl.us

The problem is that the site is transitioning to beta and is very very slow! Also if you use the beta it does not let you share the mind map or embed the code. So here it is in its slow but still glorious 1.0 form (Click the - sign in upper left to zoom out. Click and drag to see different elements, to see the full size, click the read only link at the bottom):

If you want to check it out on Bubbl.us, here is the read only link