History and Physical

 

Monday morning was our last SimMan practicum of the semester.  I was not very nervous about it this time but it turns out that perhaps I should have been.  I prepared by brushing up on my cardiac assessment and 12 lead EKG interpretation skills.  This time, instead of a team of students, there were only 2 of us.  Nicole was my partner- she's wonderful.  What we thought was initially a myocardial infarction (heart attack) ended up being heart failure.  Fortunately, we did figure that out based upon his diagnostics and decided to give him Lasix and put him on a Milrinone drip to support his heart and blood pressure.  

What was disappointing to me about our/my performance of this SimLab was that we did not pick up on his heart failure much sooner.  We failed to do a thorough history and jumped quickly to the physical exam.  If we/I had spent more time asking a detailed history, we would have found out that the patient has a history of stage IV heart failure.  I think we were a bit distracted by his need for almost immediate intubation.  We should have thought to call his 'wife' into the room for a more detailed history.  Overall, we managed to diagnose him correctly and ordered the proper treatments.  

This experience reminded me of something my brother-in-law once told me, he's an internal medicine resident in Baltimore.  He said that a physician once told him, "Nine times out of ten, if you do a thorough history and physical, you will correctly diagnose your patient."  Of course, there are always exceptions but this statement definitely held true during our SimLab. 

I hope that when I begin my career as a NP, that I will not forget this valuable lesson.  Never underestimate the importance of a detailed history and a thorough physical exam.