A useful approach before examining any patient, using the mnemonic WIPER.
1. Wind up clothes above elbow, Withdraw all jewelry and Wash your hands.
2. Introduce yourself.
3. Purpose and Permission – explain purpose and gain verbal consent (permission) to proceed with the examination.
4. Expose the patient as needed.
5. Reposition the patient to optimize the examination and stay on Right side of bed.
6. Sexual allegation caution – have a chaperone of the gender which patient is comfortable of.
Example:
- Wash your hands, remove watch and expose your clothes above the elbow.
- Introduce yourself, explain purpose and obtain permission:
- “Good morning, Mr. __________. My name is Dr. _____________. I am a resident/doctor/surgeon working in _____________ department in _____________ hospital. I understand you have pain in your right hip. I would like to examine you to find out the cause. Would that be OK?”
- Expose the patient appropriately (offer a chaperone for intimate examination; usually the same gender as the patient):
- This will require you to remove your clothing and to put on this gown. You may leave on your underwear/shorts unless a genital examination is required.
- Reposition the patient:
- Can you lay down on the examination couch?
Physical Examination for Surgeons: An Aid to the MRCS OSCE
edited by Petrut Gogalniceanu, James Pegrum, William Lynn