Outside the Norm
Prior to clinical exposure, PA students become accustomed to the normalcy of the physical exam. We can identify the S1 heart sound, palpate the typical abdomen, visualize the tympanic membrane and even examine a healthy retina. Lectures provide systemic pathology with the associated signs and symptoms, which calibrates our approach to the history.
However, it is much harder to perform a physical exam on diseased patients. Our hands, eyes and ears are more comfortable assessing healthy patients. Our professors remind us often that the abnormalities in the physical exam will be obvious because of our anatomical/physiological foundation.
In my recent hands-on experience, the abnormal definitely jumped out at me. Things like a hernia the size of a bocce ball, a grade IV murmur and melanotic stool present on a digital exam proved there were physical findings outside of normal. The experience of finding an aberration for the first time is quite odd. You inwardly say, "Cool!" while outwardly you remain composed for professional purposes. We become sensitized to the abnormalities by learning the depths of normalcy.
I guess our professors are right--if something is wrong with a patient, we will truly know it when we see it.