By Richard F LeBlond; Richard L DeGowin; Donald D Brown
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Extra resources for DeGowin's diagnostic examination
We emphasize the characteristics of diseases because a clinician who knows the manifestations of many diseases will ask the right questions, obtain the key history, and elicit the pertinent signs that differentiate one disease from another. Instructions on how to elicit the specific signs are included in the physical examination section for each region; if the maneuver is not part of the usual exam, it is discussed with the sign itself. Following the descriptions of many symptoms and signs is a highlighted Clinical Occurrence section.
These principles are critical to an efficient use of the laboratory and radiology. Chapter 18 lists many common (not "routine") laboratory tests that provide important information about the patient's condition not accessible from the history or physical examination. More specialized tests used to evaluate specific diagnostic hypotheses are not discussed. Chapters 6 to 14 have a uniform organization: (A) each chapter begins with a brief overview of the major organ systems to be considered; (B) next is a discussion of the superficial and deep anatomy of the body region; (C) the physical examination of the region or system is described in detail in the usual order of performance; (D) the symptoms particularly relevant to the body region and systems are presented; (E) the physical signs in the region or system exams are listed (some findings can be both symptoms and signs; discussion of a finding is in the section where it is most likely to be encountered, then cross referenced in the other section); and (F) discusses diseases and syndromes commonly in the differential diagnosis of symptoms and signs in the body region and systems under discussion.
After you have recorded some routine data, sit back and listen to the narrative for a while, interjecting only a few questions. Avoid writing the patient's narrative verbatim; it is usually too lengthy and poorly organized. Use of standardized forms for recording the past medical history, FH, and SH (which can be filled out by the patient before the interview) will greatly decrease the need for making notes. Remember that the patient is telling you a story; you should try to understand their story jotting down key words and phrases to assist recall.
DeGowin's diagnostic examination by Richard F LeBlond; Richard L DeGowin; Donald D Brown