Physical examination

When a doctor conducts a consultation, the questions he asks and the examination he makes broadly follow a set pattern, which of course varies according to the particular circumstances. Each doctor usually develops his own personal methodology. In contrast to a general practitioner who wants to inform himself as broadly as possible about the patient’s condition, a specialist often confines the examination to medical history, symptoms and the parts of the body relevant to his speciality.

The doctor makes notes during the consultation, to have a permanent record of what is said and done. These notes are normally kept confidential, except when disclosure is authorized by the patient or demanded by a court of law or its appointees. After taking the history (the patient’s account of what is troubling him or her), the doctor performs the examination. Many diagnoses can be made on a carefully taken history alone, but examination of the patient is made to pin-point the exact extent of the disorder, and is used later to establish any progress. Sometimes the patient may have reason to suspect that he has a particular disorder because he may have identified some of the symptoms through self-examination. Mostly, examination is narrowed down to the part of the body that appears to be giving any problems, as indicated by the history. This saves time (and money) and is more practical than a complete examination of the patient.

Like the general consultation, the examination usually follows a set sequence, with variations dictated by circumstances. Four methods of examination are traditionally taught, of which the first is inspection , the observation of the part of the body suspected of harbouring a disorder. In general, auscultation then follows with a stethoscope. This instrument amplifies body sounds produced by the heart, air passages, blood vessels and intestines (depending where it is placed), and enables the doctor to recognize changes in the sounds produced by a disorder. After this stage percussion may be performed, a special technique in which the middle finger of one hand is laid on the surface of the body and struck sharply with the middle finger of the other, producing a characteristic note. It is of particular value in examining the chest and abdomen. Finally, palpation may follow, in which the doctor feels with his hands what is beneath the skin.

Naturally, not all these methods are employed in every examination, and if you visit your family doctor with a fever, headache, muscle aches, weakness and cough, during a flu epidemic, a cursory inspection may be all that is required.