Knee Examination - Orthopaedic Knee OSCE - Medicine Explained - Clinical Skills - Dr Gill
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- čas přidán 27. 05. 2024
- Knee Examination - Orthopaedic Knee OSCE - Medicine Explained - Clinical Skills - Dr Gill
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* error clarification
Varus or valgus deformity depends on the joint you are looking at
Valgus deformity is where the bone DISTAL to a joint is angled outward, ie way from the body's midline
Thus a VARUS deformity of the knee is colloquially “bow-legged”
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This Knee Exam Deep Dive looks at the details of the examination of a patient with knee issues, highlighting what is being checked for during special tests and examination findings
In this video, we demonstrate how to perform a clinical examination of the knee for your medical school Clinical Skills OSCE. As orthopaedic exams are core skills when it comes to examining patients, students should assume that a knee assessment is a high yield station for any clinical exams or clinical assessments.
For a passing grade in your Clinical Skills OSCE, in a knee exam follow the approach of:
- Look
- Feel
- Move
HOWEVER, a knee examination OSCE station does not just involve pressing around the joint, as this video also demonstrates some of the specialised examination techniques required in examining patients such as the anterior draw test, checking for sag sign, along with discussion about McMurray's test
Reduction in movement, pain and general concerns about knee issues is a common reason for patients to see a doctor, and in general, practice is probably one of the hardest joints to accurately diagnose a problem in
This video has two other knee demonstration videos associated with it:
• Knee Examination - Ho... - Knee assessment Demo
• GALS Screen - Gait, Ar... - Gait, Arms, Legs, Spine - GALS screen
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Please note that there is no ABSOLUTE way to perform a clinical examination. Different institutions and even clinicians will have differing degrees of variations - the aim is the effectively identify medically relevant signs.
However during OSCE assessments. Different medical schools, nursing colleges and other health professional courses will have their own preferred approach to a clinical assessment - you should concentrate on THEIR marks schemes for your assessments.
The examination demonstrated here is derived from Macleods Clinical Examination - a recognised standard textbook for clinical skills.
Some people viewing this medical examination video may experience an ASMR effect
#clinicalskills #Knee #DrGill
You can now consult via video or in person with Dr Gill at Dr Finlay’s Private Practice - www.drfinlays.co.uk/services/...
Inward in valgus and varus ?!
Unfortunately a typo of Varus and valgus
The best way I’ve had is described is Varus causes “knock knees - ie can’t stop a pig in a passage way!”
@@DrJamesGill ❤️
@@DrJamesGill is tbere any cure for knock knees? It can be quitedramatic looking. Is it pai ful or in anyway debilitating?
@@DrJamesGill tryjghnnbbbvvcccccxx. CV bbbbnnncmm.cmm..mm
Fgghhbhjdjfyyghyudhdufuierijrkeiekrgiwdijqjqdjf GG yyhyueideu2ggfyuuuiiidhgGcdgVsbsjmx. Vbz 🌶️🍌
I am a fan due to the asmr aspect of Dr. Gil’s media. I do keep noticing that these videos make me ponder about how I communicate to my healthcare professionals. Seeing these practical health care applications also cause me to reflect on my health. I.e. tracking my own ailments and pain management. Thank you for the work you do, it shows in your presentation and I love the videos.
I’m glad you found it useful. Hopefully it helps you improve your own health
@@DrJamesGill 00
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@@chrissyhall8372 ?
5a5
My father yesterday was so Ill I had to call the ambulance, and they did some of the exercises Dr. Gill would do his patients (shining light into the eyes, letting his hands float in the air etc.) and I knew exactly why they did it. I used to watch these just for the unintentional asmr but whoa, It’s amazing to know what the parameds are doing
I’m sorry your father was unwell, it’s good to hear though you had a rough idea what was going on.
Hopefully that reduced some of the worry
@@DrJamesGill I did, hes out now again, it was his tinnitus that caused this
I had a similar one. Last year my son hit his head. It was nice knowing the tests the doctors were doing.
(He's fine)
@@DrJamesGill ada
@@panzerscoutempire27 k
Dr James is a national treasure
International*
Hello! I’m a 5th medical student in Mexico and just got to say, excellent video! I’m current taking my orthopedics and traumatology class, and this help me more to understand physical exploration in a patient! Thank you!
That’s a really positive thing to hear 😊
Are there any other topics - particularly from a clinical skills point - we could help with?
Wow que bien excelente, ojalá cuando hayas terminado, indiques en donde tendrás tu consultorio para ir, saludos
God and Jesus Christ always love and are moving in your life. Don’t forget to have faith. Times get hard but the Lord prevails. The Lord is faithful ❤️(just spreading the word of God)not the comment
Hi Dr! How’s doctorhood treating you haha
Another wonderful video Dr. Gill, loving it as always!
Poor girl looked so nervous :( let her know she did great!
Lots of people are like that in front of cameras, even if it's not because of nerves. You just feel like it'd be weird to stare straight into it when you're not talking, so you end up looking a little fidgety, just scanning the room not looking at anything in particular. She did do great ^^
Three years ago my knees started to hurt and I went through this exam with my doctor :)
Turns out my muscles weren't strong enough to support my weight and since then I've been going through a great fitness journey to keep them in check
keep it up, cheers!
Muscles can be a huge source of knee pain
Plus if you are are healthy weight all the better
Most polite and relaxing doctor I’ve ever seen. I love this guy.
2:59
Ah the old classic chat up line!
It doesn't work on Tinder sadly
As someone with Ehlers-Danlos Syndrome, some of those tests were making me wince. My kneecaps curve to the outside as I flex my knees, and I injured both as a kid, was diagnosed with bursitis both times. Nowadays I'm not sure it was. Informative video as always!
Bursitis is quite common, normally as there is an irritation somewhere, so more likely with EHD.
But it is a difficult condition to manage
Dr. Gill is the zenith of class and respect. Always top notch videos sir. Cheers from 🇨🇦 ✌
If we don’t show respect to our patients I) they will be less likely to come to use for help ii) we can’t expect them to show respect in return
This examination is very familiar as I have had problems with my left knee for two years now. They didn't find anything during these exams, which sucked because my knee still hurts to this day. My other knee has problems now too, caused by an accident I was in a few months ago. We love being in the Prime of our life! 😂
The examination is the initial guide. I often can’t pin down the actual problem, so then we need to order more tests
I’m 30 and have had both knees replaced and a shoulder due to rheumatoid arthritis bc I wasn’t diagnosed til age 24 they kept saying they didn’t know what was wrong and it just kept getting worse.
I'm not a doctor. I'm not a student. For personal reasons, I'm reluctant to trust much of the American health care system.
That in mind, I appreciate you, Dr. Gill. You're of sound mind and soul. Cheers.
Poor Megan looks extremely reluctant. Like she was held Hostage until forced to do a medical education video.
Thank you for your service, Megan !
I assume that it just feels weird to be on camera, and especially to be examined when there is nothing wrong with you.
This is the first video of Dr Gill that I see...and I had to subscribe immediately. He describes everything in such clear detail, which makes it easier to follow for people like me, who are not clinically trained, but fascinated by how our bodies function. Absolutely fantastic presentation, good doctor. Warm greetings from South Africa 🇿🇦
Dr Gill is the greatest doctor ever
@@panama1942 God and Jesus Christ always love and are moving in your life. Don’t forget to have faith. Times get hard but the Lord prevails. The Lord is faithful ❤️(just spreading the word of God)not the comment
God and Jesus Christ always love and are moving in your life. Don’t forget to have faith. Times get hard but the Lord prevails. The Lord is faithful ❤️(just spreading the word of God)not the comment
Nothing better than going to bed and seeing that there is a new deep dive educational video.
I’m sure one of the my students was faking asleep this week!’
I wish I had a physician like Dr. Gill. He rocks!
Vader: “where’s Abby?! Is she safe? Is she alright?
Sidious: “it seems in your persistent asmr viewage you scared her off”
Vader: “NOOOOOOOOOOO!”
Revision
NOOOOOOOOO
It's always interesting watching these medical videos, despite not having any need for them. This one especially was enjoyable for the fact that I myself have knee problems. I'd be very interested in seeing the difference in how I may test compared to this. Great video as always!
These are always on healthy patients, there are a lot of difficulties doing them with patients
Really loved this video because my dad is an orthopedic surgeon and I tore my ACL about a year ago so I am very familiar with some of these procedures. Tore it in a basketball game and luckily he was there watching and immediately rushed to the personal trainers office to examine me to see what was wrong.
I have a torn lateral meniscus and it is only through watching this video that I've learned what the physio who examined me was doing to confirm this. Very useful.
Ouch. That’s not good to hear. Hopefully physio has helped??
I love the doctor's voice!!! So soothing.
You have no idea how much I learn from your videos. I think I could spend all day looking at them 💯💯💯
I love his explanations. As a knee injury victim, I learned so much from this!
perfect timing and great upload Dr. G; just got into a bad and crazy bike crash and I am going through PT for my knees and back. much thanks, cheers !
Oh dear, motorbike or cycling
I mean both can be bad, but often motorbike crash is more severe
Hope you are ok?
@@DrJamesGill cycling, Thank you for asking. MRI showed that my R knee and leg are ok as my back, the PT seems to help . My L knee shows some fluid and loose cartilage, nothing major to worry; but the hit triggered the osteoarthritis which I did not know I had or have. The doc shot my knee with cortisone because the pain was unreal ( I stopped taken Voltaren and Norco ). I can cycle, use the elliptical, swim but I can only walk instead of jogging for now. Waiting to see the orthopedic doc; hope you do not mind I shared the medical details. cheers.
I ruptured my ACL around 20yrs ago playing football so some of these tests are familiar! I didn't have knee reconstruction surgery after it, a lot of physio and strength work. Another very interesting video
I’m sorry to hear of your injury
I’m a HUGE supporter for physio as a treatment
I did the same two years ago and never fully committed to the exercises the physio prescribed me so I’ve traded football and running for cycling
She looks thrilled to be there.
Doctor James Gill is brilliant 👏🏿
Dr: please relax
Her: I am relaxed
Dr: I'm talking to myself
I love when my surgeon says that
I always find Dr. Gill’s videos to be quite informative so that I have a more meaningful conversation with my physician.
The benefit we have with these is as much time as we need. Unfortunately clinic time is often limited affecting how much can be included
i'm almost a doctor with these videos without school and that's amazing
Can you take a look at my asshole doctor
I second Joshua's comment there. Thanks for your videos, Doc. Hugs from Brazil!
Honestly you were on my algorithm I decided to click, not only did I get to see a relaxed exam, I also got to learn something new! You got a new subscriber😊 Sir can’t wait for future vids and going to check out some old ones while I wait. Keep up the good education and work 👍🏾💪🏾
Thank you for joining us 😊
thank you for another assesment dr gill
Not in healthcare but as someone with knee problems who felt pain just watching this I found it very informative, lol.
I’m on my feet all night at work unloading trucks and restocking the sales floor of a retail store so proper shoes and posture help me a lot but with hereditary joint problems they only do so much so now I know what to look out for to seek help if need be!
For general aches like that, discussion with a physio can be useful.
Often there is a chain of things going on that might be invisible to the patient
Dr Gill is the goat bro 🔥
Another great exam, Dr. Gill! Thank you always!
👍
Love the video as always I love the A to Z list you are going through I feel no one does as detailed as you! Altho this isn't medical guidance it's still good to learn :)
We will Restart that shortly, but there’s only so much time
As someone who suffers from Osgood Schlatters it’s really really awesome seeing how these things work and how it affects the knee. Great video as always!
Thanks, I’m in the process of planning a knee anatomy video
G IS BACK
Dr.Gill thanks for making these great videos,, i wish we had doctors of your caliber over here across the big pond,, the U.S. doctors only care about money,, in & out and fleece em for all they can get,, they don't take any time at all with their patients,, and they have really crappy bedside manor,, it's even worse for people like me on a fixed income and the disabled persons that have to go to health clinics & health departments,, they have a new inexperienced P.A. every week because they can't keep a fulltime Doctor for more than a month or so at the time,, thanks again, your videos are really great...
My biggest fear at the moment is the UK developing a USA style health system
The NHS is far from perfect, and needs major reform, but my worry is that people will try to use it for profit
I'm definitely going to watch this later when I'm going to sleep and also I have bad knees so I'm paying attention
Always worth speaking to your GP if having difficulty with a joint
@@DrJamesGill try pain in both ankles, knees wrist and back and only being 23 lol
That needs looking at
@@DrJamesGill yep
I injured my MCL in 2015. My exam was nowhere near this thorough. The only advice I received was to rest the knee. It's been 7 years, without improvement. If Dr. Gill was within 100 kms of where I lived I'd be tempted to visit. Since he isn't, I'll just have to ensure I bend my knee as little as possible. No bike riding, no running, and no use of any equipment where I have to bend my knee. A nuisance, but such is life.
Has it been scanned? If it has been there that long, it certainly needs looking in to, although getting an improvement might be a challenge
@@DrJamesGill I appreciate the response. No, the doctor had me lay on the table and run my heel toward my bottom, saw the grimace on my face and made the diagnosis. I had to wait more than 1:30 for him to see me, and saw no reason to return or try another doctor. I'm not fond of people in your profession. I have a problem with my ulnar nerve and told the Dr. that it hurt when I had my hand above my shoulder (riding the bus). He had me put my hand in my lap and tested my grip. No problems with my hand lower than my shoulder, and have no idea why he then informed me that there was no problem. My ring and pinkie fingers still go numb sometimes, but I cannot imagine spending even one more minute talking to a medical professional. You might be the exception to that rule, as your videos indicate you know what you're doing.
I’m sorry you’ve had this experience
All medics are different, and rightly or wrongly will have areas where they excel, and areas where there is room for growth
Now very clearly, I’m not examining you, but the issue with little and ring finger certainly suggests an ulna nerve pathology, but it could be anywhere from neck to hand, and similarly could be positional
I’d strongly suggest arranging to see a different doctor about both issues.
Not casting aspersions on doctor no.1, but sometimes a fresh pair of eyes can be really useful.
I’ll often ask a colleague “I can’t make head nor tail of this, would you mind having a look and seeing what you think”
Really enjoy the videos from an ASMR point. Plus watching from Australia but from the UK makes Dr. Gills accent like being back home. Keep going with the vids and thank you.
Cool, thanks
I am a Clinical Exercise Physiologist with a practice focusing more on metabolic aspects rather than kinesiology & biomechanics. Thought of having some course refreshment here but his voice is so soothing I ended up enjoying this like it's an ASMR vid or podcast for me to relax & go to sleep. Damn 🤣
I work with a chap called Dr Garry Palmer - sports physiologist, did a lot of research In South Africa, but has written books on the metabolism side of things
Do you know his work?
Always enjoy this content. Would be cool to have a patients version of Where Are They Now. Lucy Brown fan here 👍🏽
Always excited to see you new videos!
I watched this video and just had to subscribe! I’m looking at my 2nd surgery on my right knee (4th surgery on both knees total) due to cartilage being torn up in my knee and causing a hole to form in my kneecap, so I’m very familiar with this exam. It was great to see exactly what my ortho was doing and hearing what he was looking for. Thank you for the insight! I look forward to watching more of your videos!
I’m sorry to hear that!
Are they going to do a graft / patch?
@@DrJamesGill They did the MACI procedure on my left knee and believe that this the plan for my right. During the initial scope, they took cartilage biopsies.
This was really helpful. I live in the country side of the north east (USA) and my friend got kicked by a horse yesterday and i pretty much imitated Dr. Gill's examinations before he was taken to a clinic. Probably not related to this video but it did help me explain to the doctors what hurt on his leg.
How are they doing now?
Good it wasn't as bad as it sounded. Luckily he didn't have any broken bones/tendons
Really High Quality Stuff Doc. Keep it up we love it
👍👍
Dr. Gill always manages to put me to sleep😴
Nice video Dr Gill
Not gonna lie but I've been waiting knee assessment from you for years
We had the demonstration previously, but this is the deep dive, looking at how we are doing the exam and what we are looking for
I wish I was able to get an appointment with a doctor like you that would do a thoroughly look over my knees they hurt and wobble so bad and hurt almost constantly I take a medication that helps but I can barley walk and can't run or bend down . I have seen a few doctors but still haven't figured out what's wrong.
They are the only 2 people who can see eye to eye with each other
Hello i am David Attenburough's Grandson and i will be your examiner today
I know a lot of us like the asmr aspect of Dr. Gil, but I learn stuff too. 20% strength loss in a few weeks due to knee pain is quite a bit. Makes me wonder how much I've lost in the past few years due to knee pain from drug damage from the antibiotic Cipro.
Ciprofloxacin is a good medication, but does have a really significant side effect of tendon injury, hence we have to be careful
Did you have a full rupture?
@@DrJamesGill no. Just pain and brain fog for years now. Through my own research I've managed to eliminate the brain fog using Huperzine-A. Cipro somehow affects acytlcholine breakdown or production. The Huperzine-A (an acetylcholinesterase inhibitor) allows the levels to come up. As for the pain, I'm currently researching glutamate as the pain appears to be neurological after initial tendon damage heals.
You might be interested in digging into the medication. It's not a "good" medication. It is a last resort medication best suited for biological attacks and extreme cases of unresponsive infection. Doctors give it out for bacterial infections that can easily be addressed with macrolides or cephalosporins.
Millions of people are suffering years after exposure to the fluoroquinilone antibiotic category. And no one wants to help us because it means standing up to the medical system, governments, and pharmaceutical companies. We are on our own to heal ourselves...thank god I paid attention in advanced biology back in high school!
Doc u should do more of these and more frequently!!! 💙
I can listen to you sir all day...
👍 as long as it is useful 😊
Two ACL reconstructions later (one patella tendon graft) and (one hamstring graft) these tests are very familiar. 👍🏻
Ouch. Why happened?
@@DrJamesGill
Two separate sports injuries.
Football on artificial grass.
Great video. Really enjoying the content.
Thanks 😊 glad it’s useful
Watching from Brazil
Welcome 😊
Detailed information thankyou ❤
Early gang!! Definitely will be watching this later 😊
Rite on doc , thanks for effortlessly teaching us something. However I apologize I keep falling asleep during your lectures 😂
I'm italian but I love your voice and accent. ❤️
Very interesting to see, and familiar. I had a tibial plateau fracture last year so i had quite a lot of these tests (and others). I would probably feel pain in certain parts of the exam 😅
Ouch!! That’s not a minor injury!! How did that happen?
@@DrJamesGill It definitely wasn't! I was hit by a car while crossing a road, riding a scooter (kinda moped). I had a green light so it was a big mind f"ck. He hit me pretty hard (flew through the air, landed on the wind screen with my head (mind you, helmets weren't compulsory yet) and flew right over the car and landed on the other side. I was lucky though. It could have ended a lot worse. But yeah, recovery was (and still is) no walk in the park.
Hi and thanks for a really great video series. Im within the volentary fire dept where i live. We train with The regular first responders. We are quite a rural area so we are usually on sight in a few minutes while The ambulance might be 30 min away or more. Anyway what i find facinating is the amount of info you can get from a patients condition with just your hands and a few simple instruments.
Absolutely. The hands really are the window to a huge amount of medicine
This reminds me I need to talk to my doctor about my knee valgus and the pain happening in my left knee 😬 an informative video as always!
Please it worked as a reminder 😊
Very useful and informative ! 👍😉
👍
First time on your channel, your voice is so relaxing 😌
I hope the context is useful
Once again, a great video. Very informative. Can I just ask if you plan on doing a video like this on the ankle/foot? I'm asking as I'd be interested in it because I've had a lot of issues in that area (broken bones in my foot, twice, and also had micro tears in the tendons connected to my toes)
We will cover that.
@@DrJamesGill thank you. I'll look forward to that as I had a complete rupture in my peroneus brevis, and a few months ago had surgery that included a brevis to longus transfer. Recovery has been long but I'm running again! Something that I thought I lost the ability to do before finally being persuaded to go to the Podiatrist and taking care of it.
Thanks for the informative vids.
Injuries that change a lot of our sports and recreational activities are REALLY hard to deal with
Glad fro hear you are running again
@@DrJamesGill I too am interested in an ankle video. I rolled my ankle so hard one time that It has never really been the same since. When I twist it It cracks like you would crack a knuckle (painless). My other ankle doesn't do that.
@@ProperSauce Mine clicks as well, especially on the stairs! Is there a chance you fractured it when you rolled it? The first time I fractured mine I though I had only rolled it as well....it's only when I broke it the second time they saw that it had been fractured previously 🙄
I'd love it if you did a similar video on the ankle
I’ve put it on the list
Dr. Gill, I was wondering if there is a link between the five steps taking in this examination and what my father used to ask me when buying shoes. He always ask me to take five steps towards the door of the shoe shop and back to the mirror. Now I was five years old when he started to take me shopping for shoes until I was 15 years old but, I never had a problem with shoes. But, one time and I just realized this...
I was in a hurry so I put one shoe on walk maybe two steps and bought them just to return them because they were uncomfortable. So. Is there a link?
Maybe. Maybe.
Thank you for my birthday gift
She reminds me of Angelique Kerber :)
Yeah
Health is everything in life in my view.
I wish that more people would value health
hora de dormir!! valeu pelo video :)
Excellent!
👍
Any chance of a throwback thyroid exam for the asmr ogs
What could it mean if you have clicking / mini popping sounds when you straighten your knees while in a sitting position? On both my knees I can feel micro clicking when I place my hand on the kneecap. It also hurts to apply pressure to the patella on both..
I’m enjoying you videos! 👍
👍
I wish I had an exam like this when I saw a physio referred to by my doctor. Have had clicking and pain in my knees for years yet the physio was more interested in examining my feet! 🤦🏼♀️
There is the kinetic chain, so the feet may be causing the knee issue. This video might help
Came to the channel for the ASMR but stayed for the medical info.
Por favor traducción al español muy interesante el tema
When you're in the chat, and Dr Gill tells you that custom orthotics in Europe are around £50, so you look it up in your area, and they're $600........
Yikes
Ouch! I think someone is seriously overcharging there! See if you can find someone doing bike fit / running gait analysis, that should be a better price
@@DrJamesGill Oh yeah that’s a lot better. Most expensive I see at our local running store is $75. Thank you!!!
👍
Thank you, again amazing and interesting. I wonder how "big" your storyboard-sessions are as preparation :D Regards from the Netherlands
I don’t fully understand. We simply do an overview of the examination on the day
We’ve always got a text book to hand to check a few things, otherwise it’s hit record and go
Rowing has dramatically improved my knee mobility. I'm unfit as fuck but rowing 15k a day on my concept 2 has allowed me to squat down like fuck without pain
Honestly- rowing is one of THE best activities when it comes to a whole body workout
@@DrJamesGill I'm addicted to it James. My splits aren't the best but I just love the repetitive motion of the rowing stroke.
i’ve always had horrible left knee pain that several doctors were never able to diagnose. now i watch these videos and cringe at how certain things hurt. thankfully, the pain isn’t as severe as it used to be, as it seems my wrist has decided to be the pain instead.
Giọng hát của ah Đức phúc hát đúng tâm trạng hay quá
You give me Patrick Jane's (from Mentalist) vibes🙌🏻✨
I really kneed it to see this video. Ill see myself out.
Har har
I guess we were due to get a new patient - but I’m not sure I’m ready for this.
Yup, it’s surprising the speed that they grow up 😢
Great video…. but also single-handedly bringing the waistcoat back.
It never went away 😊
Gosh. Smashed a knee ten years ago, I think that alternate meniscal test would've put me on the floor.
I assure the McMurray’s would be worse - I honestly try to avoid both unless absolutely required
I've had a problem since I was young where my kneecap goes out of socket to the outside of my leg, similar to your last test. When my leg is straight it's very easy to move my kneecap to the outside out of alignment, especially on my left knee.
I had to stop playing basketball in fear of it dislocating out of socket and causing crazy pain. It usually goes back by itself once the knee is bent. Any info on what this is and how I can help it doc?
That needs to be seen by orthopaedics. But they can help 😊
Ive had both knee's dislocate more times than I can count and I always hear the same thing when getting them checked out, no major damage just do physical therapy. Im 42 and im actually afraid to run at full speed . It all good until its not (like rolling over in bed my patella might start slipping) and its like an evil little jack in the box. Any advice for me? I have no aspirations to be 22 again but it would be nice to play basketball once in a while without being terrified.
In
Went through this a couple of years ago, shall we just say potholes, running across a road and stilletos don't get on. Gave myself a nice partially torn muscle
Detroit in the building!!
👍
I'm sure this is a common question, but I've always wondered to what extent can a medical professional/doctor actually diagnose themself with a condition/disease/illness given they are equipped with the correct knowledge and qualifications to do so on a patient? For example if they was to examine/feel an area of their body and be able to acknowledge and pinpoint a finding and draw the valid conclusion? And then to further the question actually prescribe themselves medication?
In the UK you can self prescribe unless exceptional circumstances
We do often pick up things on ourselves, but certainly in my case, I’ve thought a symptom was one thing, when actually another - I suppose it is the burden of knowledge, and we lose the external frame of reference we have with patients