Us third years are now in our Endocrinology block. So, for our Professional Skills section this week, we had the chance to learn a "little" on how to examine the thyroid gland.
For us clinicians, there are four methods of examination.
First is "Inspection" where we only look at the gland for any abnormalities in size and shape. Some patients may have a very large goiter but some may only have a slight enlargement. We also ask the patient to swallow because the thyroid, being enclosed completely by the pre-tracheal fascia, moves up with degluttition.
The second step is "Palpitation". The best way to palpate the thyroid gland is from behind the patient, whose head is semi-flexed so that his/her neck muscles are relaxed. This is because to palpate the thyroid, we have to insinuate our fingers under these muscles.
The next step is "Percussion". This is used to examine whether the patient has a retro-sternal protrusion of the thyroid. I'm not exactly sure to as how it is done but what I do know is it involves something about the resonance of sound. Pening pening. >.<
Lastly, "Auscultation". By using a stethoscope, we auscultate the thyroid gland for any bruits. Bruits are actually whoosh-like sounds which we can find if the gland is hypervascularized.
So during yesterday's section, the girls went up first to inspect the four LADY patients that came. One has a normal thyroid, one has a slight thyroid enlargement, another has a multinodular goiter and the last one has a very large goiter. During my observation, I noticed that very few of the girls communicated with the patient. Some simply went up and palpated the patients' gland and asked them to swallow. The patient with the multinodular goiter was especially irritated by this. Oh well, these few girls could be having some jitters since its not easy for us to examine patients.
However, most of the other girls did greet and smiled at the patients. It was a bonus for me to see how other people did it and learn from them. Thus, when my turn came, I did what the other girls have done. I simply greeted the patient and asked them, "May I?". And after I examined every patient, a "Syukran awiy" followed and the patient will look up at me, smiled and reply. It simply shows how far a soft approach and a kind voice can help clinicians during examining our patient. All of us, boys AND girls learned a lot from the section.
To be honest though, I did hesitate a little bit when it comes to holding the patients' hands to feel the temperature and condition of their skin. Haha. Sorang patient tu nampak segan bila aku nak pegang tangan dia, aku pun segan lah gak kan. Tersenyum je lah. :P
April 9, 2009