Physical Diagnosis (PDX)


What is it?
Physical diagnosis is the class where you are introduced to taking histories and basic physical examinations which can be helpful for initial diagnosis of patients.

Why is it important?
In my opinion, the most valuable skill to be learned in this class is not at all the physical exam part of it, as many of those techniques will not be frequently used in practice depending on what you are doing (many surgeons do not even use stethoscopes on a daily basis), but EVERYONE needs to know how to take and interpret a history taken from a patient. This includes people like radiologists and pathologists, because the clues to making a diagnosis on imaging or slides can also come from crucial points taken in a history by an internist.

How will you learn to do this?
For one, we have weekly lectures on physical diagnosis that are “mandatory.” I put that inquotes because attendance will not be regularly checked, but for most students it behooves you to go to learn how to do things properly and to pick up helpful tips from Dr. Fowler and other guest lecturers.

Lectures will then be put into practice in CELA sessions that you should attend, and whereattendance is taken seriously. Those are where you will actually learn and do the skills that are introduced in lecture.

Beyond that, the most useful parts of the class for me were our sessions with our physicaldiagnosis preceptors, who you will shadow in the second half of the year. They will teach you basics of history taking and presentations of patients, and then supervise your general physical exams on real patients of theirs.

What is most important?
If I had to tell you the lectures you should absolutely attend, it would be any of the ones that involve how to take an effective history. It is debatable whether the actual physical skills lectures are necessary for some, as we always have practice sessions for each set of skills learned in lectures. While these sessions are, again, technically mandatory, do not sweat it if you have had a difficult week and want to knock off to go home for the weekend or get a good work out in. You will not fall behind as you would skipping class material.

General Advice for Success and Learning
The biggest part of learning the physical exam comes from repetition. These maneuvers are not all that difficult in relative terms, but it is important to be systematic in one’s approach (This will be reiterated many times over).

History taking and presentations, however, is almost entirely learned through live action with your preceptors and any other places you have to take a history. You will not be afforded a huge number of visits with your preceptors, so it is important to take advantage of supervised practice with them. Some of you will also take histories in your Continuity Clinics, but many of you will not (I didn’t in surgery clinic).

All in all, don’t stress TOO much about physical diagnosis. You’re at Vanderbilt because people like you implicitly and you are sociable, so use those skills to your advantage. Enthusiasm and respect for the process is the most important tool for your success here. Those two things will get you farther than any amount of initial prowess you find you have in first year. Take this seriously as you would any class, but do not berate yourself for initial awkwardness. We all have to start somewhere and learn at different speeds.

Some will say practice your skills as much as possible. While this is a good idea, I don’t think it’sentirely necessary to do at this stage, but if you feel you are weak in an area, do take extra time to address it. There is much practice to be had at ShadeTree and with your preceptors, but at the end of the year there will not yet be much difference between you and your classmates. Remember, everything you learn here will be reinforced 100X during rotations, so be stressed about physical diagnosis SECOND year, not this year. For now, it is best to work on being professional, courteous, and empathetic with your simulated patients and preceptors. It is much easier to work with people who are extremely friendly and hard-working rather than extremely skilled but not so nice to patients or colleagues.