Physical examination is the process of evaluating objective anatomic findings through the use of observation, palpation, percussion, and auscultation. The information obtained must be thoughtfully integrated with the patient’s history and pathophysiology. Moreover, it is a unique situation in which both patient and physician understand that the interaction is intended to be diagnostic and therapeutic. The physical examination, thoughtfully performed, should yield 20% of the data necessary for patient diagnosis and management.
Almost without exception, some medical history about the patient is available at the time of the physical examination. Rarely, there may be no history, or at best brief recordings of acute events. Information pertinent to the physical examination can be learned from observation of speech, gestures, habits, gait, and manipulation of features and extremities. Interactions with relatives and staff are often revealing. Pigmentary changes such as cyanosis, jaundice, and pallor may be noted. Diaphoresis, blanching, and flushing may provide clues about vasomotor tone related to mood or physiologic abnormalities. Aspects of patient habits, interests, and relationships can be ascertained from pictures, books, magazines, and personal objects at the bedside.
Aside from the hospital room and office, physical examination may occur in a variety of other settings where it is difficult to establish privacy and quiet. The best resource available to the physician to set the stage for the physical examination is to communicate respect and a genuine interest in the patient’s welfare. The patient should be addressed politely and asked to perform the required maneuvers of the examination, a technique far preferable to imperative language such as, “I want you to. …” Patients should be prepared for unpleasant portions of the examination.
Aside from explanations and reassurance, it is not necessary to maintain a continuous conversation with the patient during the examination. Avoid embarrassing the patient. Be certain that draping material is used appropriately and that personal areas are not subjected to undue exposure. An examination that ends abruptly may diminish the value of the doctor–patient relationship and may destroy its therapeutic content. The patient may benefit from a brief summary of relevant findings and may require reassurance about what has and has not been found.
Credit:
Campbell EW JR, Lynn CK. The Physical Examination. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 4.