Physical examination
Physical examination | |
---|---|
ICD-9-CM | 89.7 |
MeSH | D010808 |
MedlinePlus | 002274 |
In a physical examination, medical examination, clinical examination, or medical checkup, a medical practitioner examines a
Types
Routine
The routine physical, also known as general medical examination, periodic health evaluation, annual physical, comprehensive medical exam, general health check, preventive health examination, medical check-up, or simply medical, is a physical examination performed on an asymptomatic patient for
The term is generally not meant to include visits for the purpose of newborn checks,
If done for a group of people the routine physical is a form of screening, as the aim of the examination is to detect early signs of diseases to prevent them.[3]
Evidence
Although annual medical examinations are a routine practice in several countries, examinations performed on an asymptomatic patient are poorly supported by
Some notable general health organisations recommend against annual examinations, and propose a frequency adapted to age and previous examination results (
A
Some employers [
The lack of good evidence contrasts with population surveys showing that the general public is fond of these examinations, especially when they are free of charge.[18] Despite guidelines recommending against routine annual examinations, many family physicians perform them.[19] A fee-for-service healthcare system has been suggested to promote this practice.[20] An alternative would be to tailor the screening interval to the age, sex, medical conditions and risk factors of each patient.[6][21][22] This means choosing between a wide variety of tests.[23]
Prevalence
The routine physical is commonly performed in the United States and Japan, whereas the practice varies among South East Asia and mainland European countries. In Japan it is required by law for regular working employees to have a health check once a year.[24]
History
The roots of the periodic medical examination are not entirely clear. They seem to have been advocated since the 1920s.
Comprehensive
Comprehensive physical exams, also known as executive physicals, typically include laboratory tests, chest x-rays, pulmonary function testing, audiograms, full body
Pre-employment
Pre-employment examinations are screening tests which judge the suitability of a worker for hire based on the results of their physical examination.[33] This is also called pre-employment medical clearance. Some employers believe that by only hiring workers whose physical examination results pass certain exclusionary criteria, their employees collectively will have fewer absences due to sickness, fewer workplace injuries, and less occupational disease.[33] A small amount of low-quality evidence in medical research supports this idea.[33] Furthermore, the cost of staff health insurance will be lower. However, certain exams or tests that are requested by employers, such as a baseline low back x-ray, should not be performed, according to the American College of Occupational and Environmental Medicine. Reasons for this include the legality and medical necessity of the test as well as the inability of such testing to predict future problems, the radiation exposure to the worker, and the cost of the exam.[34]
Insurance
A physical examination may be provided under health insurance cover, required of new insurance customers. This is a part of insurance medicine. In the United States, physicals are also marketed to patients as a one-stop health review, avoiding the inconvenience of attending multiple appointments with different healthcare providers.[35][36]
Uses
Diagnosis
Physical examinations are performed in most healthcare encounters. For example, a physical examination is performed when a patient visits complaining of flu-like symptoms. These diagnostic examinations usually focus on the patient's chief complaint.[citation needed]
Screening
General health checks, including physical examinations performed when the patient reported no health concerns, often include
Doctor-patient relations
Physical examination has been described as a ritual that plays a significant role in the doctor-patient relationship that will provide benefits in other medical encounters.[37] When a physical exam is expected by the patient but is not performed by the provider, patients may express concern for the lack of depth of investigation into their illness, the validity of treatment plans and exclusions, and the doctor-patient relationship.[38]
Other uses
By extension, the term "health check" is also used for routing checks on the working of equipment [39] or business operations or solvency.[40]
Format and interpretation
A physical examination may include checking
Scope
Although providers have varying approaches as to the sequence of body parts, a systematic examination generally starts at the
While the format of examination as listed below is largely as taught and expected of students, a specialist will focus on their particular field and the nature of the problem described by the patient. Hence a cardiologist will not in routine practice undertake neurological parts of the examination other than noting that the patient is able to use all four limbs on entering the consultation room and during the consultation become aware of their hearing, eyesight, and speech. Likewise an orthopaedic surgeon will examine the affected joint, but may only briefly check the heart sounds and chest to ensure that there is not likely to be any contraindication to surgery raised by the
With the clues obtained during the history and physical examination the healthcare provider can now formulate a
While elective physical exams have become more elaborate, in routine use physical exams have become less complete. This has led to editorials in medical journals about the importance of an adequate physical examination.[42][43] Physicians at Stanford University medical school have introduced a set of 25 key physical examination skills that were felt to be useful.[44]
Recording
Section | Sample text | Comments |
---|---|---|
General | "Patient in NAD. VS: WNL" | May be split on two lines. "WNL" = "within normal limits" |
HEENT: | "NC/AT. tympanic membrane WNL, neck supple"
|
"Neck" is sometimes split out from "Head". "Good dentition" may be noted. |
Resp or "Chest" | "Nontender, CTA bilat" Chest expansion test, normal breathing with little effort, absence of wheezing, rhonchi and crackles. | More detailed examinations can include WNL", and "no dullness to percussion". |
CV or "Heart" | "+S1, +S2, RRR, no m/r/g" | If "CV" is used instead of "heart", peripheral pulses are sometimes included in this section (otherwise, they may be in the extremities section) |
Abd | "Soft, nontender, nondistended, absence of pain, no NBS "
|
If lower back pain is involved, then the "Back" may become a primary section. RLQ tenderness". "NBS" stands for "normal bowel sounds"; alternatives might include "hypoactive BS" or "hyperactive BS".
|
Ext | "No clubbing, cyanosis, edema" | Checking the fingers for clubbing and cyanosis is sometimes considered part of the pulmonary exam, because it closely involves oxygenation. Examinations of the knee may involve the McMurray test, Lachman test, and drawer test. |
Neuro
|
"A&Ox3, reflexes WNL, normal gait "
|
Sensation may be expanded to include dull, sharp, vibration, temperature, and position sense. A mental status exam may be reported at the beginning of the neurologic exam, or under a distinct "Psych" section.
|
Depending upon the
History
The
The medical history and physical examination were supremely important to diagnosis before advanced health technology was developed, and even today, despite advances in medical imaging and molecular medical tests, the history and physical remain indispensable steps in evaluating any patient. Before the 19th century, the history and physical examination were nearly the only diagnostic tools the physician had, which explains why tactile skill and ingenious appreciation in the exam were so highly valued in the definition of what made for a good physician. Even as late as 1890, the world had no radiography or fluoroscopy, only early and limited forms of electrophysiologic testing, and no molecular biology as we know it today. Ever since this peak of the importance of the physical examination, reviewers have warned that clinical practice and medical education need to remain vigilant in appreciating the continuing need for physical examination and effectively teaching the skills to perform it; this call is ongoing, as the 21st-century literature shows.[47][48]
Society and culture
People may request modesty in medical settings when the health care provider examines them.
In many Western societies, a physical exam is required to participate in extracurricular sporting activities. During the physical examination, the doctor will examine the genitals, including the penis and testicles. The doctor may ask the teenager to cough while examining the scrotum. Although this can be embarrassing for an adolescent male, it is necessary to help evaluate the presence of inguinal hernias or tumors.[49]
See also
- Heart sounds – Noise generated by the beating heart
- Medical record – Medical term
- Mental status examination – Way of observing and describing a patient's current state of mind
References
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- Talmage J, Belcourt R, Galper J, et al. (2011). "Low back disorders". In Kurt T. Hegmann (ed.). Occupational medicine practice guidelines : evaluation and management of common health problems and functional recovery in workers (3rd ed.). Elk Grove Village, IL: American College of Occupational and Environmental Medicine. pp. 336, 373, 376–377. ISBN 978-0615452272.
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- ^ Brink S (18 February 2008). "$2,000 physicals for busy execs". Los Angeles Times. Retrieved 16 July 2009.
- ^ Armour LA (21 July 1997). "2,500 executives flock to Rochester, Minn., for a deluxe, soup-to-nuts physical at the Mayo clinic. Our man went for a tune-up to find out why". CNN.com. Retrieved 16 July 2009.
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