Duty to Carefully Examine

The physical examination is an important part of a visit to the doctor. Medical studies have found that about 80% of conditions can be diagnosed using only the patient's family history and the physical examination. There is not just one right way to conduct a physical examination because it is largely dependent on the symptoms the patients is experiencing. Instead, medical originations offer general guidelines to doctors about how doctors should complete these examinations.

Doctors have a duty to their patients to perform a complete physical examination. Failing to properly perform these examinations can result in diagnostic errors that can have serious consequences on the patient.

Importance of the Physical Examination

A comprehensive physical examination can expose a variety of diseases of which the patient may not have been aware. Before performing a physical examination, doctors must explain the purpose of the examination to patients and request permission to complete it.

Obtaining the patient's consent is important for building trust between the patient and the doctor, and is also an important legal step for the doctor to take so the patient is aware of the care that is being provided by their doctor. In gaining consent, doctors must explain to patients what the examination will consist of, and what parts of the body will be examined. Doctors must make physical notes of the patient's consent.

If a patient does not consent, the doctor cannot continue with the examination. If a patient is unable to consent for him or herself, a family member or designated decision-maker should provide consent.

The physical examination is closely tied to the patient's health history, discussed on another page. Doctors will complete the physician examination in relationship to the information the patient provides during the history. Though doctors will always need to complete a full examination on every patient, the doctor will more acutely focus on areas where the patient is experiencing symptoms.

Performing the Physical Examination

Doctors can learn a lot about patients before they even begin the physical examination. The health history of the patient will provide vital information for the doctor to use to cater the physical examination to the patient's unique condition. Doctors can also learn a lot by simply observing the patient; the skin color, gait, and attention of the patient can all provide insight into the patient's condition.

There are certain ethical guidelines doctors are expected to follow when performing a physical examination. The doctor should respect the privacy of the patient and provide a private room along with an appropriate gown if the patient needs to change. Doctors should not make inappropriate remarks or non-verbal expressions during the examination, and should avoid unnecessary examinations.

Doctors should have a specific list of necessary examinations in mind when performing a physical examination. General physicians should be competent in examining the:

Vital signs
Doctors should begin the physical examination with an overview of the vital signs of the patient. This includes the blood pressure, heart rate, respiration rate, and temperature of the patient.

Cardiovascular system
Doctors should listen to the patient's heart with a stethoscope and note any irregularities in the heartbeat.

Pulmonary system
Doctors will also use a stethoscope to listen to the lungs of patients and detect irregular noises like crackles and wheezes that could point to lung disease.

Head and neck
Doctors will examine the tonsils, teeth, and gums of the patient, along with the ears, nose, eyes, and lymph nodes.

Abdominals
Doctors will examine the abdomen by tapping to test for tenderness and listening to the bowel with a stethoscope. The doctors will also talk to the patient about indigestion, abdominal pain, and any changes in bowels.

Neurological exam
Doctors will examine the neurological state of the patient by analyzing the patient's gait as they walk into the room and by making note of any irregularities in speech or movement. Doctors will talk to the patient about headaches, dizziness, vision loss, or personality changes that have occurred.

Mental state
Doctors may complete a mini-mental state examination (MMSE) if they have reason to be concerned about the mental state of the patient. The MMSE will identify cogitative impairment in the patient including memory issues.

Extremities exam
Doctors will test for sensory problems in the arms, legs, and joints.

Skin
The doctor may examine the skin of the patient for rashes or other specific symptoms.

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