Monday, November 17, 2008

Inspect, Palpate, Auscultate... Pain

There is a method to the madness of physical examination in medicine. The key steps are often cited with the acronym IPPA - inspection (look), palpation (feel), percussion (tap), and auscultation (listen). It all sounds quite simple in theory, but it's been giving me surprising difficulty. Let me explain why...

I'm sure most people have been percussed by a physician before, or at least have seen a doctor percuss a patient. This involves putting down the middle finger of one hand on the patient, and then tapping that middle finger with the middle finger of the other hand. The sound that results can alert the doctor as to whether the underlying structure is air-filled (like the lungs), fluid-filled, or solid tissue. Its diagnostic relevance is significant, as it can notify the physician if there is fluid in an air-filled space, air in a soft tissue space, or enlargement of an organ.

So what's the problem?

Fingernails.

As I practiced percussion, I found that I really don't make the loud, hearty sounds that one would really like to hear when percussing (it's not easy to interpret a sound if you can't hear it). This is largely due to the fact that I have been angling my finger to avoid stabbing myself with my fingernail. You might think this could be solved quite easily but simply cutting my fingernails, and perhaps that in fact as a male member of our species I should actually be careful to maintain short and presentable nails.

The problem is, my fingernails are short already. In fact, they're less than a millimeter. It just so happens that I have a genetic disposition whereby my fingernails finish perilously close to the end of my finger. Lovely if you're a lady who wants to grow long, beautiful nails. Not so great for percussion (or piano playing... as I produce clicking on the keys even when my nails are fully cut).

In any case, I decided that since percussion is a key technique, I needed to triumph over these defiant fingernails. I clipped my middle finger nail down to an infinitesimally short length so that I could drop it down with the appropriate perpendicularity. It worked. That extra millimeter actually made my percussion sound better!

The only problem is that after a few goes at it, my finger started to hurt like heck. In fact, it was traumatized by just about everything that it subsequently touched. By the end of the day, my finger was actually bleeding between the fingernail and the finger from the distress. So while the nail might be the right length so that I can percuss skin to skin, the pain makes such a procedure unreasonable.

Whoever came up with the method for percussion was obviously rather clever, but they certainly didn't have me in mind. Right now, I'm more inclined to believe that second P in IPPA stands not for percussion, but pain.

1 comment:

Alexis said...

Aww.. that's horrible! Maybe you should do some Hanon exercises and that will make your taps louder without having to cut your fingernails so close. By the way, I found out what was wrong with the way your blog showed on my computer and I fixed it! =)