A website for clinical medicine

http://meded.ucsd.edu/clinicalmed/introduction.htm

Introduction

This guide has been assembled with an eye towards clinical relevance. It represents a departure from
the usual physical exam teaching tools which, in their attempts to be all inclusive, tend to de-emphasize
the practical nature of patient care. As a result, students frequently have difficulty identifying what
information is truly relevant, why it's important and how it applies to the actual patient. By approaching
clinical medicine in a pragmatic and demystified fashion, the significance of the material should be
readily apparent and the underlying principles more clearly understood. In particular:
1. Each section is constructed to answer the question: "What do I really need to know about this area of
medical care?" The material covered is presented in a concise, ordered fashion that should be readily
applicable to the common clinical scenarios that you will actually see in day to day practice. Esoterica
has been purposely excluded.
2. The Web-Based format allows for easy access to information and provides integration of text,
pictures, and sound.
3. Exam techniques are described in step-by-step detail. Special maneuvers that are frequently utilized
are also described.
4. The rationale for each aspect of the examination is addressed and, where appropriate, relevant
pathophysiology discussed.
5. Detailed descriptions of how to function in clinical settings are included. In general, students identify
their role in patient care either by trial and error or through the beneficence of more advanced
students, residents or staff. This is not particularly efficient and diminishes the potential for learning and
fun. The following sections are included to specifically address this issue: a. Oral presentations
b. Patient write-ups
c. Working in outpatient clinics
d. Functioning on an inpatient service
e. Clinical decision making

6. Pictures clearly identifying appropriate techniques accompany each section. Examples of common
pathologic findings are included as well.
7. Images of gross anatomic correlates (denoted by the "daVinci Icon" shown above) are incorporated
within a number of the segments.
8. Video clips of selected examination maneuvers and findings.
9. Carefully selected links to other useful websites are available.

I hope that this site helps to make the educational process both fun and rewarding. As the skills required
of a physician cannot be learned from any single source, I encourage you to make use of as many other
references as possible. This should reinforce basic principles and alert you to the fact that there are
often many ways of achieving the same end (i.e. there is frequently no single right way of doing
something). What follows, then, serves merely as an introduction. I have tried to capture those core
behaviors that define clinical excellence and will have prolonged applicability, even in a technology
driven world. The learning process continues (I hope) until the day you stop practicing medicine. There
are always new techniques to learn and unusual findings to incorporate into your personal libraries of
medical experience. However, unless you take the time to build a solid foundation, you will never have
confidence in the accuracy and value of what you can uncover with a sharp mind, agile fingers and a few
simple tools!

Please Note: Medical and non medical practitioners are welcome to use this site for learning purposes.
However, it is not meant as a substitute for appropriate evaluation of medical conditions or pursuit of an
advanced education through traditional mechanisms. While the authors welcome feedback and
comments, please do not solicit medical advice.

This site is, and will always remain, a work in progress. I look forward to receiving any and all
comments/suggestions/feedback (use the link to my e-mail, located at the top of each page).


Charlie Goldberg, M.D.
University of California, San Diego School of Medicine
San Diego VA Medical Center

Jan Thompson


University of California, San Diego School of Medicine
San Diego, CA




September, 2004