The physical examination is an important part of the diagnostic process. Although slightly embarrassing and a little uncomfortable at times – especially if the doctor has cold hands – it complements the case history and can provide valuable confirmatory evidence for a particular illness.
Sometimes doctors will carry out a physical screen, examining many of the body systems, but this is mostly done for insurance medicals and the like. More often the physician will home in on one or two areas that have been flagged by the case history. For example in a patient who complains of shoulder pain the doctor will examine the shoulder for tenderness and movement. But as pain can be referred to the shoulder from the upper abdomen, then this area may be examined as well.
Common Aspects of the Physical Examination
The examination always starts with a look at the patient’s general demeanour. Such things as skin tone, posture, approximate weight, gait and voice are noted. Then, after the case history, the physical examination of relevant areas begins.
- Ears, nose, throat and eyes: frequently examined in suspected infection. May infections start in the throat and can go on to affect the ears, particularly in children. In cases of tinnitus and deafness the first thing the doctor will look for is ear wax blocking the auditory canal. The first sign of some viral infections is increased secretion from the eyes. The eyes are also examined for blood vessel changes due to high blood pressure.
- Skin: rashes of various types commonly take people to the doctor. They can be a symptom of infections – measles and chicken pox for example or be due to a skin disorder such as psoriasis. Allergies frequently manifest on the skin. The skin may also be examined for abnormal moles, it being vitally important that melanoma is diagnosed early. If you are suffering from melanoma you can have a melanoma cancer treatment done by professional doctors.
- Chest: any suspected heart condition or chest problem will inevitably lead to examination with the iconic stethoscope. In the heart, abnormal sounds from a leaking valve, for example, or irregular beats may be sought. In persistent chest infection the doctor will listen for signs of pneumonia.
- Abdomen: complaints of abdominal pain will lead to palpation of the abdomen. Tenderness and swellings are felt for. Inflammation of the bowel, ovaries or bladder will often produce pain on pressure. Gall bladder inflammation may give a characteristic very sharp pain on firm pressure over the liver.
- Musculoskeletal system: strains and sprains will lead to the affected area being examined for swelling, spasm and any limitation of movement. Joints are also examined in arthritis. In osteoarthritis joints may be swollen but are not usually red and hot. In rheumatoid arthritis the joints can be red, hot and swollen. Different types of arthritis will often present with a characteristic pattern of joint involvement
- Nervous system: damage to the nervous system can arise from a number of causes. Trauma, whether to the head, spine or peripheral nerves, degenerative disease such as multiple sclerosis and tumours will all leave tell tale signs. Such functions as balance, coordination and eye movements are examined. Commonly, reflexes, skin sensation and muscle power are tested. These check the functioning of the circuits from the brain down the spine and those from the spine to the muscles and skin. Any abnormalities could be due to nerve entrapment, nerve degeneration or problems with the system’s control centre – the brain.
Any abnormalities found in the physical examination may well lead to further specialist investigation such as blood tests or imaging.
This article is for information only. If you have any health concerns you should consult your doctor.