A physical examination is the evaluation of a body to determine its state of health. The techniques of inspection include palpation (feeling with the hands and/or fingers), percussion (tapping with the fingers), auscultation (listening), and smell. A complete health assessment also includes gathering information about a person's medical history and lifestyle, conducting laboratory tests, and screening for disease. These elements constitute the data on which a diagnosis is made and a plan of treatment is developed.
The term annual physical examination has been replaced in most health care circles by periodic health examination. The frequency with which it is conducted depends on factors such as the age, gender, and the presence of risk factors for disease in the person being examined. Health-care professionals often use guidelines that have been developed by organizations such as the United States Preventative Services Task Force. Organizations such as the American Cancer Society or American Heart Association, which promote detection and prevention of specific diseases, generally recommend more intensive or frequent examinations, or suggest that examinations be focused on particular organ systems of the body.
Comprehensive physical examinations provide opportunities for health care professionals to obtain baseline information about individuals that may be useful in the future. They also allow health care providers to establish relationships before problems occur. Physical examinations are appropriate times to answer questions and teach good health practices. Detecting and addressing problems in their early stages can have beneficial long-term results.
Every person should have periodic physical examinations. These occur frequently (monthly at first) in infants and gradually reach a frequency of once per year for adolescents and adults.
A complete physical examination usually starts at the head and proceeds all the way to the toes. However, the exact procedure will vary according to the needs of the person being examined and the preferences of the examiner. An average examination takes about 30 minutes. The cost of an examination will depend on the charge for professional time and any tests that are included. Most health plans cover routine physical examinations, including some tests.
Before examiners question the patient, they will observe a person's overall appearance, general health, and behavior. Measurements of height and weight are made. Vital signs such as pulse, breathing rate, body temperature, and blood pressure are recorded.
With the person being examined in a sitting position, the following systems are reviewed:
- Skin. The exposed areas of the skin are observed; the size and shape of any lesions are noted.
- Head. The hair, scalp, skull, and face are examined.
- Eyes. The external structures are observed. The internal structures can be observed using an ophthalmoscope (a lighted instrument) in a darkened room.
- Ears. The external structures are inspected. A lighted instrument called an otoscope may be used to inspect internal structures.
- Nose and sinuses. The external nose is examined. The nasal mucosa and internal structures can be observed with the use of a penlight and a nasal speculum.
- Mouth and pharynx. The lips, gums, teeth, roof of the mouth, tongue, and pharynx are inspected.
- Neck. The lymph nodes on both sides of the neck and the thyroid gland are palpated.
- Back. The spine and muscles of the back are palpated and checked for tenderness. The upper back, where the lungs are located, is palpated on the right and left sides and a stethoscope is used to listen for breath sounds.
- Breasts and armpits. A woman's breasts are inspected with the arms relaxed and then raised. In both men and women, the lymph nodes in the armpits are felt with the examiner's hands. While the person is still sitting, movement of the joints in the hands, arms, shoulders, neck, and jaw can be checked.
While the person is lying down on the examining table, the examination includes:
- Breasts. The breasts are palpated and inspected for masses.
- Front of chest and lungs. The area is inspected with the fingers, using palpation and percussion. A stethoscope is used to listen to internal breath sounds.
The head should be slightly raised to examine:
- Heart. A stethoscope is used to listen to the heart's rate and rhythm. The blood vessels in the neck are observed and palpated.
The person being examined should lie flat for an examination of the:
- Abdomen. Light and deep palpation is used on the abdomen to feel the outlines of internal organs, including the liver, spleen, kidneys, and aorta, a large blood vessel.
- Rectum and anus. With the person lying on the left side, the outside areas are observed. An internal digital examination (using a gloved finger), is usually done for persons over 40 years old. In men, the prostate gland is also palpated.
- Reproductive organs. The external sex organs are inspected and the area is examined for hernias. In men, the scrotum and testicles are palpated. In women, a pelvic examination is completed using a speculum and a sample for a Papanicolaou test (Pap test) may be taken.
- Legs. While lying flat, the legs are inspected for swelling, and pulses in the knee, thigh, and foot area are found. The groin area is palpated for the presence of lymph nodes. The joints and muscles are observed.
- Musculoskeletal system. With the person standing, the straightness of the spine and the alignment of the legs and feet is noted.
- Blood vessels. The presence of any abnormally enlarged veins (varicose), usually in the legs, is noted.
In addition to evaluating a person's alertness and mental ability during the initial conversation, inspection of the nervous system may include:
- Neurologic screen. The person's ability to take a few steps, hop, and do deep knee bends is observed. The strength of the handgrip is felt. While sitting in an upright position, the reflexes in the knees and feet can be tested with a small hammer. The sense of touch in the hands and feet can be evaluated by testing reaction to pain and vibration.
- The 12 nerves in the head (cranial) that are connected directly to the brain. They control the senses of smell and taste, strength of muscles in the head, reflexes in the eye, facial movements, gag reflex, vision, hearing, and muscles in the jaw. General muscle tone and coordination, and the reaction of the abdominal area to stimulants like pain, temperature, and touch may also be evaluated.
The individual being examined should be comfortable and treated with respect throughout the examination. As the examination continues, examiners should explain what they are doing and share any relevant findings. Using language appropriate to the person being examined improves the effectiveness of communications and ultimately fosters better relations between examiners and examinees.
Before visiting a health care professional, individuals should write down important facts and dates about their own medical history, as well as those of family members. There should be a complete listing of all medications and their dosages. This list should include over-the-counter preparations, vitamins, and herbal supplements. Some people bring their bottles of medications with them. Any questions or concerns about medications should be written down.
Before the physical examination begins, the bladder should be emptied. A urine specimen is usually collected in a small container at this time. The urine is tested for the presence of glucose (sugar), protein, and blood cells. For some blood tests, individuals may be told ahead of time not to eat or drink for 12 hours prior to the test.
Individuals being examined usually remove all clothing and put on a loose-fitting hospital gown. An additional sheet is provided to keep persons covered and comfortable during the examination.
Once a physical examination has been completed, the person being examined and the examiner should review what laboratory tests have been ordered, why they have been selected, and how and with whom the results will be shared. A health professional should discuss any recommendations for treatment and follow-up visits. Special instructions should be put in writing. This is also an opportunity for persons to ask any remaining questions about their own health concerns.
There are virtually no risks associated with a physical examination. Complications with the process of a physical examination are unusual. Occasionally, a useful piece of information or data may be overlooked. More commonly, results of associated laboratory tests compel physicians to recheck an individual or reexamine portions of the body already reviewed. In a sense, complications may arise from the findings of a physical examination. These usually trigger further investigations or initiate treatment. They are really more beneficial than negative, as they often begin a process of treatment and recovery.
Normal results of a physical examination correspond to the healthy appearance and normal functioning of the body. For example, appropriate reflexes will be present, no suspicious lumps or lesions will be found, and vital signs will be normal.
Abnormal results of a physical examination include any findings that indicate the presence of a disorder, disease, or underlying condition. For example, the presence of lumps or lesions, fever, muscle weakness or lack of tone, poor reflex response, heart arrhythmia, or swelling of lymph nodes will indicate possible health problems.
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American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (913) 906-6000. E-mail: http://email@example.com. http://www.aafp.org .
American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (847) 434-4000; Fax: (847) 434-8000. E-mail: http://firstname.lastname@example.org. http://www.aap.org/default.htm .
American College of Physicians. 190 N Independence Mall West, Philadelphia, PA 19106-1572. (800) 523-1546, x2600, or (215) 351-2600. http://www.acponline.org .
American Medical Association. 515 N. State Street, Chicago, IL 60610. (312) 464-5000. http://www.ama-assn.org .
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L. Fleming Fallon, Jr. MD, DrPH
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
A physical examination is best performed by a trained physician. Other health care professionals such as physician assistants and nurse practitioners have similar but limited training. Examinations are usually performed in professional medical offices or hospitals. Occasionally, they may be performed in private homes or in the field.
QUESTIONS TO ASK THE DOCTOR
- What are my results, both normal and abnormal?
- What has changed since the last physical examination?
- What do you recommend as a result of the findings of this physical examination?
- When do you want to repeat the physical examination?