Bates’ Visual Guide to Physical Examination

6.6 Recording your Findings Video Transcript

Narrator: Remember that a clear, well-organized clinical record, employing language that is neutral, professional and succinct is one of the most important adjuncts to patient care.

Doctor: Twenty-five-year-old otherwise healthy female with concerns about increasing number of moles occurring over the past three months. Exam shows color is good, skin warm and moist. Nails without clubbing or cyanosis.

Narrator: After practice and further review of this video, make sure you have mastered the important learning objectives for examining the patient’s skin, hair and nails.