Yes. Yes there are!
The chest exam is a case in point.
Does your doctor listen to your heart or lungs first? When listening to your lungs do they listen for a fraction of a second or do they listen to the entire inspiration/expiration cycle? Do they listen to both sides or all four quadrants? Do they listen to the lungs at the front of your chest or at your back?
In medical school I was taught to listen to all four quadrants of the chest at the back and to listen to the entire inspration/expiration. Otherwise you can miss something important. And yet as a student and resident I watched attending after attending as well as residents, and students listen for a fraction of a second on each side and declare the patient to have a negative lung exam. I call bull shit.
Lest you think I am better than everyone else, though:
No one ever taught me to listen to the heart first. Not officially. We did heart and lung modules separately. So I developed a nasty habit of listening to the lungs first…
“Uh, doc? That made me kinda dizzy!”
Many people are not used to breathing that deeply for that long. THEN, I immediately tell them to breath “normally” so that I can listen to the heart.
Try that with me now. Four long, slow deep breaths then stop and imagine someone listening to your heart… trying to breath quietly, shallowly, while staying still.
Damn near impossible.
And yet, I cannot for the life of me switch it! I have that habit so rote, so ingrained, that I do it without even thinking. If I do happen to remember and switch it up, it disrupts my entire process for the rest of the exam and I look like some sort of stammering fool. A lot like other things in our lives that we cling to, huh? Things that are not exactly the best for us or anyone else but we cling to them because the change is too much to contemplate?
Now that I have confessed and written about it, displayed my dirty laundry for all to see, I will have to change in order to maintain credibility. I know you will be watching…
I would love to hear what your own physician does during your exams!