Approach And Overview

In this section, we outline the comprehensive physical examination and provide an overview of all its components. You will conduct a comprehensive physical examination on most new patients or patients being admitted to the hospital. For more problem-oriented, or focused, assessments, the presenting complaints will dictate what segments of the examination you elect to perform. You will find a more extended discussion of the approach to the examination, its scope (comprehensive or focused), and a table summarizing the examination sequence in Chapter 3, Beginning the Physical Examination: General Survey, and Vital Signs. Information about anatomy and physiology, interview questions, techniques of examination, and important abnormalities are detailed in Chapters 3 through 16 for each of the segments of the physical examination described below.

It is important to note that the key to a thorough and accurate physical examination is developing a systematic sequence of examination. At first, you may need notes to remember what to look for as you examine each region of the body; but with a few months of practice, you will acquire a routine sequence of your own. This sequence will become habit and often prompt you to return to an exam segment you may have inadvertently skipped, helping you to become thorough.

As you develop your own sequence of examination, an important goal is to minimize the number of times you ask the patient to change position from supine to sitting, or standing to lying supine. Some segments of the physical examination are best obtained while the patient is sitting, such as examinations of the head and neck and of the thorax and lungs, whereas others are best obtained supine, as are the cardiovascular and abdominal examinations. Some suggestions for patient positioning during the different segments of the examination are indicated in the right-hand column in red.

Most patients view the physical examination with at least some anxiety. They feel vulnerable, physically exposed, apprehensive about possible pain, and uneasy about what the clinician may find. At the same time, they appreciate th e clinician's concern about their problems and respond to your attentive-ness. With these considerations in mind, the skillful clinician is thorough without wasting time, systematic without being rigid, gentle yet not afraid to cause discomfort should this be required. In applying the techniques of inspection, palpation, auscultation, and percussion, the skillful clinician examines each region of the body, and at the same time senses the whole patient, notes the wince or worried glance, and shares information that calms, explains, and reassures.

For an overview of the physical examination, study the following example of the sequence of examination now. Note that clinicians vary in where they place different segments of the examination, especially the examinations of the musculoskeletal system and the nervous system. Some of these options are indicated below. With practice, you will develop your own sequence, keeping the need for thoroughness and patient comfort in mind. After you complete your study and practice the techniques described in the regional examination chapters, reread this overview to see how each segment of the examination fits into an integrated whole.

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