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In a physical examination, medical examination, clinical examination, or medical checkup, a medical practitioner examines a patient for any possible medical signs or of a Disease. It generally consists of a series of questions about the patient's medical history followed by an examination based on the reported symptoms. Together, the medical history and the physical examination help to determine a diagnosis and devise the treatment plan. These data then become part of the medical record.
The term is generally not meant to include visits for the purpose of newborn checks, Pap smears for cervical cancer, or regular visits for people with certain chronic medical disorders (for example, diabetes). The general medical examination generally involves a medical history, a (brief or complete) physical examination and sometimes laboratory tests. Some more advanced tests include ultrasound and mammography.
If done for a group of people the routine physical is a form of screening, as the aim of the examination is to detect early signs of diseases to prevent them. (2025). 9780199214495, Oxford University Press. ISBN 9780199214495
Some notable general health organisations recommend against annual examinations, and propose a frequency adapted to age and previous examination results (risk factors).US Preventive Services Task Force. Guide to Clinical Preventive Services: Report of the Preventive Services Task Force 2nd ed. Baltimore, Md: Williams & Wilkins; 1996. The specialist American Cancer Society recommends a cancer-related health check-up annually in men and women older than 40, and every three years for those older than 20.
A systematic review of studies until September 2006 concluded that the examination does result in better delivery of some other screening interventions (such as Pap smears, cholesterol screening, and faecal occult blood tests) and less patient worry. Evidence supports several of these individual screening interventions.Screening for Lipid Disorders in Adults, Topic Page. June 2008. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspschol.htm Screening for Colorectal Cancer, Topic Page. July 2002. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspscolo.htm Screening for Cervical Cancer, Topic Page. January 2003. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspscerv.htm The effects of annual check-ups on overall costs, patient disability and mortality rate, disease detection, and intermediate end points such a blood pressure or cholesterol, are inconclusive. A recent study found that the examination is associated with increased participation in cancer screening.
Some employers require a mandatory health checkup before hiring a candidate, even though it is now well known that some of the components of the prophylactic annual visit may actually cause harm. For example, lab tests and exams that are performed on healthy patients (as opposed to people with symptoms or known illnesses) are statistically more likely to be "false positives"—that is, when test results suggest a problem that does not exist. Disadvantages cited include the time and money that could be saved by targeted screening (health economics argument), increased anxiety over health risks (medicalisation), overdiagnosis, wrong diagnosis (for example athletic heart syndrome misdiagnosed as hypertrophic cardiomyopathy) and harm, or even death, resulting from unnecessary testing to detect or confirm, often non-existent, medical problems or while performing routine procedures as a followup after screening. The lack of good evidence contrasts with population surveys showing that the general public is fond of these examinations, especially when they are free of charge. Despite guidelines recommending against routine annual examinations, many family physicians perform them. A fee-for-service healthcare system has been suggested to promote this practice. An alternative would be to tailor the screening interval to the age, sex, medical conditions and risk factors of each patient. This means choosing between a wide variety of tests.
While the format of examination as listed below is largely as taught and expected of students, a specialist will focus on their particular field and the nature of the problem described by the patient. Hence a cardiologist will not in routine practice undertake neurological parts of the examination other than noting that the patient is able to use all four limbs on entering the consultation room and during the consultation become aware of their hearing, eyesight, and speech. Likewise an orthopaedic surgeon will examine the affected joint, but may only briefly check the heart sounds and chest to ensure that there is not likely to be any contraindication to surgery raised by the anaesthetist. A primary care physician will also generally examine the male genitals but may leave the examination of the female genitalia to a gynecologist.
With the clues obtained during the history and physical examination the healthcare provider can now formulate a differential diagnosis, a list of potential causes of the symptoms. Specific diagnostic tests (or occasionally empirical therapy) generally confirm the cause, or shed light on other, previously overlooked, causes. The physical exam is then recorded in the medical record in a standard layout which facilitates billing and other providers later reading the notes. patient in hospital|alt=]]While elective physical exams have become more elaborate, in routine use physical exams have become less complete. This has led to editorials in medical journals about the importance of an adequate physical examination. Physicians at Stanford University medical school have introduced a set of 25 key physical examination skills that were felt to be useful.
| General | "Patient in NAD. Vital signs: WNL" | May be split on two lines. "WNL" = "within normal limits" |
| HEENT: | "NC/AT. PERRLA, EOMI. No cervical lymphadenopathy, no thyromegaly, no bruit, no pallor, fundus WNL, oropharynx WNL, tympanic membrane WNL, neck supple" | "Neck" is sometimes split out from "Head". "Good dentition" may be noted. |
| Resp or "Chest" | "Nontender, CTA bilat" Chest expansion test, normal breathing with little effort, absence of wheezing, rhonchi and crackles. | More detailed examinations can include rales, rhonchi, wheezing ("no r/r/w"), and Liniment. Other phrases may include "no cyanosis or clubbing" (if section is labeled "Resp" and not "Chest"), "fremitus WNL", and "no dullness to percussion". |
| CV or "Heart" | "+S1, +S2, RRR, no Heart murmur/r/Gallop rhythm" | If "CV" is used instead of "heart", peripheral pulses are sometimes included in this section (otherwise, they may be in the extremities section) |
| Abd | "Soft, nontender, nondistended, absence of pain, no hepatosplenomegaly, bowel sounds" | If lower back pain is involved, then the "Back" may become a primary section. Costovertebral angle tenderness may be included in the abdominal section if there is no back section. More detailed examinations may report "+psoas sign, +Rovsing's sign, +obturator sign". If tenderness was present, it might be reported as "Direct and rebound RLQ tenderness". "NBS" stands for "normal bowel sounds"; alternatives might include "hypoactive BS" or "hyperactive BS". |
| Ext | "No Nail clubbing, cyanosis, edema" | Checking the fingers for clubbing and cyanosis is sometimes considered part of the pulmonary exam, because it closely involves oxygenation. Examinations of the knee may involve the McMurray test, Lachman test, and drawer test. |
| Neurologic exam | "A&Ox3, cranial nerve II-XII grossly intact, Sense intact in all four extremities (dull and sharp), DTR 2+ bilat, Romberg negative, cerebellar reflexes WNL, normal gait" | Sensation may be expanded to include dull, sharp, vibration, temperature, and position sense. A mental status exam may be reported at the beginning of the neurologic exam, or under a distinct "Psych" section. |
Depending upon the chief complaint, additional sections may be included. For example, hearing may be evaluated with a specific Weber test and Rinne test, or it may be more briefly addressed in a cranial nerve exam. To give another example, a neurological related complaint might be evaluated with a specific test, such as the Romberg maneuver.
The medical history and physical examination were supremely important to diagnosis before advanced health technology was developed, and even today, despite advances in medical imaging and molecular , the history and physical remain indispensable steps in evaluating any patient. Before the 19th century, the history and physical examination were nearly the only diagnostic tools the physician had, which explains why tactile skill and ingenious appreciation in the exam were so highly valued in the definition of what made for a good physician. Even as late as 1890, the world had no radiography or fluoroscopy, only early and limited forms of electrophysiologic testing, and no molecular biology as we know it today. Ever since this peak of the importance of the physical examination, reviewers have warned that clinical practice and medical education need to remain vigilant in appreciating the continuing need for physical examination and effectively teaching the skills to perform it; this call is ongoing, as the 21st-century literature shows.
In many Western societies, a physical exam is required to participate in extracurricular sporting activities. During the physical examination, the doctor will examine the genitals, including the penis and testicles. The doctor may ask the teenager to cough while examining the scrotum. Although this can be embarrassing for an adolescent male, it is necessary to help evaluate the presence of inguinal hernias or tumors.
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