Do a Full History and Physical

Here's a tip to current instructors of medical students, as well as to hopefully myself in the future: never tell a student to do a "full history and physical" without defining exactly what that means in the given context. I've gotten that piece of advice from a huge number of instructors and residents, some of them otherwise very good instructors.

The idea, presumably, is that I should be thorough at my stage in training. Lacking enough experience to know exactly what the right questions are, it's better to ask too many questions and have some be meaningless than to ask too few and miss important details. Same goes for physical exam - too much is preferable to too little. That I get.

But a true "full history" would be a waste of time for everyone involved, not least for the patient. I can ask every question I can think of, even if it's unlikely to have any relevance. I can do every physical exam test I know of, but most would be useless if not nonsensical. What most people mean when they say "do a full history and physical" is "cover the standard questions and examinations for this specialty". Yet, what the standard is changes from specialty to specialty, sometimes dramatically. In kids I learned that I should pretty much always look in their ears. In adults? Not so much. The only way to know that for an otherwise naive student is to be told.

That's where "do a full history and physical" really fails - it's specific to the speaker, who lives wholly within the context of one specialty, but is vague to the listener, who jumps between specialties with regularity.

So in the future, when talking to an undifferentiated learner in medicine, please, just say "always ask this, this and this, then do this, this and this on exam". It'll be far more helpful than to say "do a full history and physical".