TAKING SIGNS AT THE BEDSIDE

1. The way to learn physical signs is at the bedside, with guidance from a senior doctor or an experienced colleague. This insight is simply an aide-memoire both on the wards and when preparing for exams.
2.   We ask questions to get information to help with differential diagnosis. But we also ask questions to find out about the lives our patients live so that we can respect them as individuals. The patient is likely to notice and reciprocate this respect, and the rapport that you build with your patient in this way is a key component to diagnosing and managing their disease. 
3. Patients (and diseases) rarely read textbooks, so don’t be surprised that some symptoms are ambiguous, and others meaningless. Get good at recognizing patterns, but not so good that you create them when none exist. We all fall into this trap! 
4. Signs can be easy to detect, or subtle. Some will be found by all the new medical students, others require experienced ears or eyes. Remember, you can be a fine doctor without being able to elicit every sign.1 However, finding signs and putting together the clues they give us to find a diagnosis is one of the best parts of being a doctor. It is also essential that we learn those signs that highlight diseases we should never miss. However, in an exam, if you cannot find a sign, never be tempted to make up something you think should be there. If the examiner is pushing you to describe something you cannot see, be honest and admit you cannot see it. Learning is a lifelong process, and nobody becomes a consultant overnight.