The physical exam was once described as a dead art because medical professionals nowadays highly rely on modern diagnostic tests and might easily overlook the importance of a complete physical exam. There are numerous skills that we need to fine tune during our clinical year, and doing a good physical exam is one of them. I’ve already had medicine and surgery rotations, and we had lots of practice performing physical exams on patients. However, I was quite surprised when during the anesthesia rotation the importance of a physical exam was stressed even more.
A thorough physical exam is required for every patient before an anesthetic protocol can be developed. This makes sense when we decide which premedication we are going to use to sedate the patient. One thing that we need to pay special attention to during a physical exam for an anesthesia patient is the temperament, such as being friendly, nervous, or excited. A patient’s temperament may not impact our diagnostic or treatment plan a lot in medicine and surgery, however, it’s kind of a big deal for anesthesia. If a patient is excited or nervous, premedications that can worsen the excitement could lead to a difficult induction and rough recovery from anesthesia.
We have many ways to monitor patients during anesthesia. However, the patient’s response is as important as what’s shown on the machines. For example, we check reflexes, the position of the eyeball, and muscle tone to assess the depth of anesthesia. Successful management of anesthesia consists of accurate interpretation of the monitor and examination of the patient itself. That’s why it’s essential for us to practice physical exams and learn to read the information conveyed by the patient’s body. The patient itself is the most reliable source of clinical information that we have.