Basic Components of a Routine Physical Examination

Components of a PERIODIC HEALTH Examination

A periodic health examination is an evaluation of the body and its functions using inspection, palpation, percussion, and auscultation. A complete health assessment includes information about ones medical history and lifestyle, laboratory tests, and disease screening. A periodic health examination can help identify health problems at an early stage when they are easier to control or cure (Laine). Another benefit of these visits is that over time the patient may develop rapport and trust with his/her physician. The type of doctor to visit to obtain a periodic health examination is a primary care physician. The following physicians qualify as primary care: general practitioners are trained in medical disciplines, including internal medicine, pediatrics, obstetrics, gynecology, general surgery and psychiatry. Internists diagnose and medically treat disease in adults. Pediatricians care for and treat children from birth through adolescents.

Preparation for a Periodic Health Examination

Before visiting the health care professional, the patient should write down important facts and dates about his or her medical history, as well as those of family members. A list of all medications with their doses should be recorded, or the bottles may be brought in. Any other general concerns should also be written down.

Before the health examination begins, the bladder should be emptied, and a urine specimen may be collected in a small container. For some blood tests, the patient may be told ahead of time not to eat or drink after midnight. Once at the physician's office, the patient usually removes all clothing and puts on a loose-fitting hospital gown. An additional sheet is provided to keep the patient covered and comfortable during the examination.

Basic Components of a Periodic Health Examination

Before the health examination, the patient should inform the physician about his or her diet, exercise, alcohol and tobacco use, sexual behavior, family disease history, and any symptoms. This information is important because it affects risk factors for various illnesses.

A periodic health examination starts at the head and proceeds to the toes. The exact procedure will vary according to the needs of the patient and examiner preferences. An average examination takes about 30 minutes. The cost of the examination will vary, depending on the charge for physician time and any tests that are performed. Most health plans cover these health examinations including some tests.

The physician will first observe the patient's appearance, general health, and behavior, along with measuring height, weight, and vital signs, which includes pulse, breathing rate, body temperature, and blood pressure. With the patient sitting upright, the following systems are reviewed (Wildes and Anderson):

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 are observed with an ophthalmoscope in a darkened room.

Ears. The external structures are inspected. An otoscope may be used to inspect internal structures.

Nose and sinuses. The external nose is examined. The nasal mucosa and internal structures are 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 typically palpated.

Back. The spine and muscles of the back are palpated and checked for tenderness. The upper back is palpated on the right and left sides and a stethoscope is used to listen for lung 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 patient is sitting, movement of the joints in the hands, arms, shoulders, neck, and jaw are checked.

With the patient lying down on the examining table, the examination includes:

Breasts. The breasts are palpated and inspected for lumps.

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 assess the:

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 patient should lie flat to assess:

Abdomen. Light and deep palpation is used on the abdomen to feel the outlines of internal organs including the liver, spleen, kidneys, and aorta.

Rectum and anus. With the patient lying on the left side, the outside areas are observed. An internal digital examination is performed if the patient is 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 is palpated. In women, a pelvic examination is performed using a speculum and a Papamnicolaou test may be taken.

Legs. With the patient 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.

Musculoskeletel system. With the patient 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, usually in the legs, is noted.

In addition to evaluating the patient's alertness and mental ability during the initial conversation, additional inspection of the nervous system may be indicated. The patient's ability to take a few steps, hop, and perform deep knee bends is observed. The strength of the hand grip is felt. With the patient sitting down, the reflexes in the knees and feet are tested with a small hammer. The sense of touch in the hands and feet are evaluated by testing reaction to pain and vibration. General muscle tone and coordination, and the reaction of the abdominal area to stimulants like pain, temperature, and touch would are evaluated.

Health Examination Aftercare

Once the physical examination has been completed, the patient and the examiner should review what laboratory tests have been ordered and how the results will be shared with the patient. The medical professional should discuss any recommendations for treatment and follow-up visits. Special instructions should be recorded in writing. This is also an opportunity for the patient to ask any remaining questions about his or her own health concerns.