Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

Overview

The technique of history taking, combined with the art (and skill) involved in physical examination, still remains the basis of diagnosis (despite advances in medical technology). This process requires correlation and interpretation of the patient's symptoms and signs. The skill is in placing these factors in proper perspective. To be in a position to do this, good anatomical knowledge is vital.

After arriving at a provisional diagnosis, a decision is then made regarding the need for investigation or surgical intervention.

image

Any surgical condition requires a thorough pre-operative and post-operative assessment, as well as an evaluation of intra-operative progress. The reasons for the decision to operate, and the results expected by all parties (patient, family and treating doctors), depend on assessment, explanation and (informed) consent.

This program attempts to travel a difficult road - to be applicable in its content to clinical students, surgical trainees, general practitioners and (perhaps) even surgeons in need of revision. The surgical conditions explored are limited to the common conditions encountered by the target audience.

image

The Surgical History

Clinical assessment leads to a differential diagnosis. The information gained leads to a tissue, site and process 'cross-matching' to help define the specific problem. The approach taken varies in each situation and depends on assessing:

  • i) Why the patient is there (defining the presenting complaint)

    image

  • ii) What is the nature of that reason (assessment of the complaint)

    image

  • iii) Who the patient is (assessment of the patient)

    image

The presenting complaint considered alone is of little value - the patient as a whole must be considered. The process of assessment and definition can only be consistently successful by ordered (yet flexible), multifactorial history taking.

The patient offers a presenting complaint. In order to make the diagnosis, there must be definition of system, region and (pathological) process. The nature of the complaint defines the order of approach. Assessment begins with one or more of four definitions:

  • i) Location

    image

  • ii) System

    image

  • iii) Process

    image

  • iv) Undefined

    image

More specific assessment of this information will direct the clinician in history taking.

image

Vedio Graphic Jump Location
Video 01-01: Principles of the Surgical History

image
Play Video

The Surgical Examination

A general medical examination tends to look at the whole body in a directed pattern. The surgical examination is directed by the history and is dependent on the nature of the presenting complaint.

The examination may be:

  • i) Direct

    image

  • ii) Extended

    image

  • iii) Regional

    image

  • iv) Systemic

    image

  • v) General

    image

With a defined location, (e.g. a lump) the approach is mainly ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.