Before beginning the sequential physical examination, it is important to take a moment just to look at the patient. Unless one’s brain has been designed by nature to be like that of Arthur Conan Doyle’s medical school teacher, Dr Bell (see Chapter 26), one must systematically seek and record specific observations about the patient’s general appearance. I still suggest to medical students that they read the stories about Sherlock Holmes (who was modeled on Dr Bell) to learn the excitement of drawing inferences from precise observations, but the student will continue this practice only if reinforced by success. Unfortunately, he will not achieve that success unless he knows what to look for. As Goethe said, “Was man weiss, man sieht” (what one knows, one sees). On a piece of scratch paper, write down what season of the year is referred to in the phrase in Fig. 5-1. If you wrote down the word “spring,” you are correct. No doubt, you read the sign as saying “Paris in the spring.” However, that is not what it says. Go back and read it again, and if you still see the same thing, read it aloud, word by word, pointing at each word on the sign with your finger.

Orient, Jane M.. Sapira’s Art and Science of Bedside Diagnosis . Lippincot (Wolters Kluwer Health). Kindle Edition

Fig. 5-1.