HOW A PHYSICAL EXAMINATION SHOULD BE PERFORMED

HOW A THOROUGH PHYSICAL EXAM SHOULD BE PERFORMED

The public does not generally understand what is involved in performing a complete and thorough physical examination. It is not the purpose of this article to provide the average person with a detailed knowledge of how to perform an examination, but if it can give one some basic understanding on how is should be done, I feel it would be worthwhile. I am not a physican, but besides assessing Social Security disability cases, I have also have assisted doctors over the years when a physcial examination was performed. In the process I have become very familiar with the proper way of conducting an exam.

Today, it is true that many examinations are not sufficiently complete which can result in overlooking important findings which can lead to serious adverse results. It is easy to understand since many physicians are very busy and tend to do exams in a hurried fashion. If a patient has a specific compaint such as a cold, or sore throat, then the physician can zero in on that problem and determine that it is not necessary to do a complete examination. However, if one presents with a serious or complex medical problem, then a very thorough examination is needed. If the patient has no complaints and feels well but desires a full examination, then one can proceed. It is a good idea to be prepared and write down your questions in advance for the doctor. Also, you shoud check the doctor’s credentials online through the Board of Medical Specialists at certificationmatters.org.

The examination should be done in good light with the patient undressed wearing a gown. AN EXAM CANNOT BE DONE PROPERLY THROUGH CLOTHING. Many diseases can be hidden under clothing. As an example, I once was involved when the doctor saw a patient complaining of a hard knot in his groin. Since he suspected a tumor, he checked his leg and found nothing unusual, but after taking off his sock, a melanoma was found on the sole of his foot. This turned out to be the cause of the mass in his groin since the melanoma had spread up his leg. In another case, a teen aged boy came in with very high blood pressure which is quite unusual. On checking his legs, It was found he had very faint pulses. It was suspected that he may have had some type of blockage in his aorta which turned out to be a coarctation or narrowing of the aorta supplying blood to the legs. Following surgery, his blood pressure returned to normal.

LISTEN TO THE PATIENT

Taking the patient’s history is very important. Sometimes, the doctor can have a fairly good idea as to the diagnosis just by carefully listening to what the patient says and relates his history; The manner of speaking may give a clue as to whether one has suffered a stroke such as showing slurred speech or an acutual inability to speak. As part of of the interview, the doctor should perform what is called a review of systems which basically means asking about any problems related to their heart, lungs, kidneys, bowels, skin or joints, plus any surgical procedures or allergies.they may have had.. In addition, he should ask about your familiy medical history regarding cancer, heart disease, diabetes, etc. It is very important to know if there is a history of smoking and what medications one is taking including use of drugs and alcohol.

THE EXAMINATION

An examination should begin with measuring the patient’s temperature. Also, height and weight should be checked. This will give the BMI results of the patient which stands for.body mass index. A BMI will indicate whether one is underweight, at normal weight or overweight. Also, the level of oxygen shouild be assessed by attaching a small plastic clamp to the index finger. This device is called a pulse oximeter which measures the level of oxygen in the blood. A normal value is between 92 and 97%. Levels below this may indicate lung or heart problems.

THE SKIN

 There are many possible causes for changes in the skin, ranging from numerous benign(harmless) growths to malignant lesions and various rashes. The main point is that the doctor should examine the entire skin surface.

HEAD, FACE AND NECK

The head, ears, nose, throat and face should be examined. If the patient can hear normal conversation, hearing is probably normal. However, if there is some doubt, the person can be referred for an audiological examination which can detect any problems with hearing whether it is is mild or moderate. A flattening of one side of the face may indicate a stroke or perhaps Bell’s Palsy. The ears, nose and throat should be inspected with appropriate instruments, the nose with a speculum and the ears with an otoscope. The neck should be checked for signs of a mass which could indicate a tumor. Also, the doctor should place his stethoscope over the caroitid artery on each side of the neck to detect abnormal sounds; this may give a clue to an underlying blockage which could lead to a stroke. Also, the neck should be checked for enlargement of the thyroid gland ( goitre). The eyes may reveal evidence of cataracts or signs of inflammation. Using an ophthalmoscope, changes in the retina may show signs of retinopathy often due to diabetes. An examination should also include having the patient moves his eyes in various directions to test for possible weakness of eye muscles. A yellowish cast to the whites of one’s eyes may be due to jaundice. If one suspects glaucoma or other potentially serious eye problems, the patient should be referred to an ophthalmologist.

THE CHEST

The patient should be observed for any signs of shortness of breath The doctor should listen to the chest for abnormal sounds such as wheezing and check the heart for evidence of enlargement and listen for sounds of a murmur as well as note the rate and rhythm of the heart. Is it regular or irregular?. In women, both breasts should be examined for signs of an abnormal mass. In addition, the doctor should feel in both arm pits(axillae) for any lumps which may indicate spread of a tumor from the breast.

THE ABDOMEN

While lying on your back, the doctor will press on the abdomen in different areas searching for masses which may suggest a tumor or some other abnormality. Also, he will check for tenderness as well as for possible enlargement of the liver or other organs. In addition, he will note if there is general swelling of the abdomen which may suggest fluid within the abdomen or what is called ascites. Finally, it is very important that a rectal examination be done to rule out a tumor as well as searching for any prostate abnormalities. Examination of the male genitalia should be done; In women a pelvic examination should be carried out.

THE BACK

Is the spine straight or curved? Test for tenderness in various areas. How far can the patient bend and straighten his back and is it painful.

RANGE OF MOTION OF SHOULDERS, HIPS, KNEES AND ANKLES

Test for range of motion of both shoulders, hips, knees and ankles and look for swelling of the knees and ankles. Is the patient significantly limited in reaching overhead and in different directions and is pain associated with these maneuvers.

THE LEGS

Pulses in both legs should be checked; for thoroughness, they should be examined in both groins, behind the knees and in both feet. If pulses are weak this may suggest blockage of blood flow and poor circulation,inidicating the presence of peripheral vascular disease. In addition, the doctor should look for signs of bluish discoloration of the feet(cyanosis) which also suggests poor blood circulation. In addition, one should, check for evidence of varicose veins which could cause swelling of the legs. Examine both feet for possible bunions or other deformities which could cause pain on walking.

THE NEUROLOGICAL EXAM

Check for the patient’s mental status; alert or confused. Ask the patient questions such as date and place of birth; address, name of president. Names of children, etc.

Observe how the patient walks; Is it normal, painful or limping and is a cane required. Strength in the legs should be checked. It is also important to test for sensation in the legs and feet. Often in cases of diabetic neuropathy or other types of neuropathy, sensation will be diminished. Loss of sensation in the legs/feet can cause problems with balance. One should also test hand functions and strength as well as note any loss of muscle wasting in the hands; In cases suspected of having arthritis or carpal tunnel syndrome, note how the patient picks up small coins and write as well as test for grip strengths in both hands.. Also, the doctor should check for reflexes in both legs. This is done by using a rubber tipped hammer-like device and tapping just below the knee. This should produce an involuntary jerk-like movement.

A full physical examination does take time and may be somewhat uncomfortable, but what is more important than your health? I hope this information improves your understanding of what is involved in a complete physical examination.