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Reviews

The Warning Signs of a Less-Than-Adequate Physical Exam, Part 1

Timothy B. McCall, M.D.

After the interview, the physical exam is the doctor's most important tool to diagnose medical problems. During the exam the doctor begins to test hypotheses formed during the interview. Of course, there is no one right way to conduct a physical exam but some methods are preferable to others. The following warning signs could help to tip you off if your doctor is performing a less-than-adequate physical exam.

• The Exam Isn’t Thorough

As with the medical interview, to perform an adequate physical exam, a doctor must devote enough time to it. It’s difficult to generalize about how detailed an exam should be, since what’s necessary depends on many factors including your symptoms, your past medical problems and your age. As you deal with different doctors, however, you’ll probably notice that some are more thorough than others—examining more of you and spending more time on each area. Since a physical exam is cheap and safe, there is much to be gained and little to be lost from being meticulous.

This is not to say that you should expect a complete physical exam every time you visit the doctor. Instead, based on information from the interview, the doctor decides which parts of the physical exam to focus on. One basic rule of thumb is to look where the symptoms are. If your arm hurts it should be examined. If you have a cough, the doctor ought to look at your throat and listen to your lungs.

• You Aren't Asked to Change for The Exam.

For anything beyond a minor complaint, a doctor usually can't do an adequate exam unless you change out of your street clothes. I have nonetheless seen numerous examples of doctors examining the heart by sliding their stethoscope down the front of a patient's shirt or listening to the lungs through several layers of clothing.

• Vital Signs Aren’t Taken.

The first part of the physical exam is the taking of the so-called vital signs: the temperature, the pulse, the blood pressure and the breathing rate. The name “vital signs” is appropriate—they are vital. People are rarely acutely ill if their vital signs are normal and at times, a change in the vital signs can be the first signal that sometime is not right. I have seen occasions where a jump in the pulse or in the breathing rate was the only sign heralding a pneumonia or a blood clot in the lungs. A seemingly minor alteration in a vital sign can alert your doctor that further questions, examination or tests may be necessary.

Failure of a doctor (or a nurse) to measure your vital signs may signal an inadequate physical exam. As important as vital signs are, some doctors probably don't pay as much attention to them as they should. This is part of the general devaluation of the physical exam in favor of blood tests and X-rays and other high-tech interventions. There are times, of course, when it isn't necessary to take all four vital signs. If you twist your ankle playing basketball, the doctor probably won't take your temperature (although it certainly doesn't hurt and the result may be surprising and lead to something else being discovered).

Next: The Warning Signs of a Less-Than-Adequate Physical Exam, Part 2

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