Thursday 10 February 2005
Physical examination generally follows the taking of the medical history, an account of the symptoms as experienced by the patient.
Together with the medical history, the physical examination aids in determining the diagnosis and devising the treatment. This data then becomes part of the medical record.
Although doctors have varying approaches as to the sequence of body parts, a systematic examination generally starts at the head and finishes at the extremities.
After the main organ systems have been investigated by inspection, palpation, percussion and auscultation, specific tests may follow (such as a neurological investigation, orthopedic examination) or specific tests when a particular disease is suspected (e.g. eliciting Trousseau sign in hypocalcemia).
With the clues obtained during the medical history and physical examination the doctor can now formulate a differential diagnosis, a list of potential causes of the symptoms and signs.
Whilst the format of examination as listed below is largely as taught and expected of medical students, a specialist will focus on their particular field and the nature of the problem described by the patient.
The physical examination is recorded in the medical record in a standard layout which facilitates others later reading the notes.