Approach to a patient during physical examination

FC Fong, Year 3, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia

8 March 2016

Proper conduct of a physical examination helps gather information and puts the patient at ease. This short article offers advice on how to approach a patient for a physical examination.

Making the patient comfortable

Courtesy. Be gentle and courteous [Talley and O’Connor, 2014a]. It is good practice to know the patient’s name [Das, 2013b].

Privacy during examination. Take all reasonable steps to ensure that the examination is private [Douglas et al, 2013b]. But remember that pulling the curtains around the bed obscures vision but not sound [Douglas et al, 2013a]! Make sure the patient’s position is comfortable [Talley and O’Connor, 2014a].

Adequate exposure is needed, but cover areas not being examined [Das, 2013a].

An attendant nurse must be present if a male is examining a female patient [Das, 2013a]. For examination of the genital or anal areas, ask if the patient would like a chaperone and include the chaperone’s name in the record. Unless the adult patient requests relatives to say, ask them to leave temporarily [Talley and O’Connor, 2014a].

Preventing discomfort. When palpating the abdomen, make sure hands are warm. Ask if any particular area is tender, and examine it last. Encourage the patient to breathe gently through the mouth [Talley and O’Connor, 2014b]. Position the patient comfortably supine with only one or two pillows to relax the muscles of the abdominal wall [Douglas et al, 2013c]. If necessary, ask the patient to bend knees [Talley and O’Connor, 2014b]. Ask the patient to place arms by the side, also to relax the abdominal muscles [Douglas et al, 2013c]. Observe the patient’s face for any sign of discomfort throughout the examination [Talley and O’Connor, 2014b].

Lighting and exposure

The examination is best conducted in a warm, well-lit room [Talley and O’Connor, 2014a]. Daylight is better for observing jaundice, which may be missed in artificial light [Das, 2013a].

For a complete examination, the patient should take off all clothes and be covered only by a dressing gown [Das, 2013a].

Where to stand

Stand on the right side of the bed [Talley and O’Connor, 2014a]. This is conventional, but also makes sense for right-handers. There seems to be no reason why left-handers should not stand on the patient’s left [Qayyum et al, 2009].

Hand hygiene

Always wash your hands before and after examining patients [Talley and O’Connor, 2014a]. Proper hand hygiene can reduce the nosocomial infection rate by as much as 40% [Kampf et al, 2009].

References

  • Das S. A manual on clinical surgery. 10th ed. Kolkata; 2013a. pg 4.
  • Das S. A manual on clinical surgery. 10th ed. Kolkata; 2013b. pg 1.
  • Douglas G, Nicol F, Robertson C, editors. Macleod’s clinical examination. 13th ed. Edinburgh; 2013a. pg 42.
  • Douglas G, Nicol F, Robertson C, editors. Macleod’s clinical examination. 13th ed. Edinburgh; 2013b. pg 2.
  • Douglas G, Nicol F, Robertson C, editors. Macleod’s clinical examination. 13th ed. Edinburgh; 2013c. pg 180-181.
  • Kampf G, Löffler H, Gastmeier P. Hand hygiene for the prevention of nosocomial infections. Dtsch Arztebl Int. 2009 Oct;106(40):649-55.
  • Talley NJ, O’Connor S. Clinical examination: a systematic guide to physical diagnosis. 7th ed. New South Wales; Churchill Livingstone; 2014a. pg 28-29.
  • Qayyum MA, Sabri AA, Aslam F. Medical Aspects Taken for Granted. Mcgill J Med 2007;10(1):47-9
  • Talley NJ, O’Connor S. Clinical examination: a systematic guide to physical diagnosis. 7th ed. New South Wales; Churchill Livingstone; 2014b. pg 197.
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