descriptive

one finds that in medicine there are few opportunities for creativity. the language, though it is its own language, feels, well, trite. it's the same words in the same order, over and over again. no wonder i tune out when the residents present to me.

to spice it up a little bit, i like to find le mot juste for presenting each case. the best opportunity is usually in the part of the physical examination called "general appearance". this is the part where you describe what the patient looks like in general. duh. the key and most oft-used phrases for this particular section are "no acute distress" or "no obvious discomfort".

people pause when they read the "general appearance" section of my charts. it is because i write such things as

• rambunctiously toddling about.
• drooling, wide-eyed, and propping to breathe.
• drooling, smiling, and playful.
• quietly exploring drawers of exam room.
• listless and glassy-eyed.
• climbing upon chairs, table, and examiner.
• malodorous. scratching his bottom.
• whining and clinging to mother.
• vomiting into a bucket in darkened exam room.
• screaming inconsolably as though in pain.
• screaming delightedly while tossing paper from exam table into air.
• calm. alert. asking for popsicle.

if applicable, i will add "NAD" (for "no acute distress") just for good measure, in case the reader doesn't get the picture.

medical students take note. this IS the most important part of the child's physical examination.