I'm Dr. Joshua Schwimmer, a nephrologist and internal medicine physician in New York City. • Kidney Notes was the first active nephrology blog. (Trivia: Kidney Notes is so old that the National Library of Medicine still uses it as an example of how to formally cite blogs.) • Professionally, you can find me at Kidney.nyc. • Kidney Notes is for educational purposes only, not medical advice. Consult qualified health care professionals. See disclaimer.

Friday, April 21, 2006

"How to Conduct a Physical Exam on an Assaultive Patient"

Via Intueri:
1. If possible, learn why the assault occurred. Did the patient feel cornered? Did s/he perceive the police as engaging in offensive maneuvers and thus reacted defensively? Did s/he believe that other people were trying to trying to steal his/her identity by staring into his/her eyes for exactly ten seconds? Inquire into the specifics of the assault prior to speaking with the patient. This information will help guide your interactions with him/her.

2. Introduce yourself to the patient and inform him/her that you shall be performing a physical exam. You may need to explain, in detail, what a “physical exam” is, as some patients may believe that this entails invasive maneuvers, while others do not realize that this means you will be touching the patient. Something succinct, such as “I will listen to your heart and lungs, push your belly, tap you with this hammer”, usually suffices. (NB: Some people may take offense to the word “belly”, as that may insinuate that their torsos are of larger mass than you deem appropriate. Choose your words wisely.)

3. Observe the patient’s reaction to your announcement. Should s/he immediately threaten to hit, bite, spit at, or kill you in a loud voice while giving you The Stare of Death, it would be wise to defer the exam. Your personal safety is important....
(The whole thing is well worth reading.)

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