I actually used gloves. While I was putting them on, I said things along the lines of "I will be doing a general Physical exam on you and move on to the specific exam. After that, I will give you my impression of the findings."
At this moment i would like to perform a physical examination, but first i would like to wash my hands, is that ok with you?
You can either be quiet and think your plan of action, or to avoid that 30 seconds without talking, you can ask the patient, is there anything you forgot to tell me? , or i would just take a second, let me just finish drying my hands.
Some say use that time to think, i liked asking that question while washing my hands. Neither is wrong.
I asked them about stress and counselled about stress; or told them what examination I was planning to do. You can also do MMSE if you want.
Whatever you do, don't be silent, and make sure you maintain some eye contact while you wash/wear gloves. I already finished talking about everything else in one case, so I asked the SP a few questions about favourite sport and team.
Pauses are awkward in real life, they're awkward in the exam too.
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