ChapterOne:

Rambling Permutations of Synaptic Excess

Who am I writing this book for? Who is my audience? Why am I writing this book? What is the meaning of life? Just kidding. I am writing this book for medical students, nurse practitioner students, physician assistant students and others embarking on their exhilarating and intimidating journey into the terra incognito jungle of the clinical practice ofmedicine.

Prior to entering the life of clinical medical training, my educational life consisted of the traditional lecture, read, memorize; lecture, read, memorize; lecture, read, memorize, then finally try to understand approach to education. Entering my clinical training, I was stunned by the transition to the random apprenticeship method of clinical teaching. Astounded, dumbfounded, stupefied and startled are other synonymatic adjectives which round out my description of my reaction to my entry into the “practice” of clinicalmedicine.

Clinical medical training is remarkably and profoundly apprentice-like. In elementary school, in high school, in college and in the first two years of medical school my courses were taught within a logical framework in which the flow of knowledge ran from beginning concepts through intermediate concepts to more complex concepts. This seemingly logical method of instruction was the only method of instruction I had experienced throughout my formal educationalcareer.

When I began my actual medical clinical training, the method of training, the method of education, the method of instruction changed drastically. I entered a random realm in which my learning depended on whichever patients, happenstance sent my way. I entered a seemingly accidental and arbitrary method of instruction, in which my learning depended on whichever mentors, teachers and patients, Tyche, the Greek goddess of chance, the capricious dispenser of good and ill fortune, placed in my meandering, seemingly drunken walk, lifepath.

I wish in this book to discuss in broad, sweeping strokes some basic concepts and some basic precepts inherent in the “proper” practice of taking a medical history and the “proper” practice of performing a medical physical examination. I wish to provide you with an understanding and a philosophical and psychological approach to your interactions with patients. I wish to provide you with some sense of an outline and advice in how to structure and perform your patient history taking and your patient physicalexaminations.

You will learn about history taking and physical examination performance far more from hands on experience than from didactic presentations. History taking and physical examination performance are not activities you have ever done before. If you are anything like me, you will find taking an excellent medical history and performing and excellent physical examination di