Physical Examination Techniques for Health Care Professionals

Physical examination is a vital skill for health care professionals, such as nurses, paramedics, pharmacists, and health care assistants. It is the process of evaluating the physical condition of a patient by using observation, palpation, percussion, auscultation, and smell. Physical examination can help to:

• Establish rapport and trust with the patient.
• Obtain objective and subjective data about the patient’s health status.
• Identify normal and abnormal findings.
• Confirm or rule out possible diagnoses.
• Monitor the progress and response to treatment.
• Provide health education and counselling.

However, physical examination also requires proper knowledge, technique, and practice. Health care professionals need to be familiar with the anatomy, physiology, and pathology of the different body systems and organs. They also need to know how to use the appropriate instruments and equipment, such as stethoscopes, thermometers, blood pressure cuffs, and otoscopes. Moreover, they need to know how to perform the physical examination in a systematic, comprehensive, and respectful manner.

There are four basic methods or techniques that are used for physical examination: inspection, palpation, percussion, and auscultation.

• Inspection is the process of visually examining the patient’s body for any signs of disease or injury, such as colour, shape, size, symmetry, movement, or lesions. Inspection can be done with or without the use of instruments, such as a penlight or an ophthalmoscope. Inspection can reveal information about the skin, hair, nails, eyes, ears, nose, mouth, throat, neck, chest, abdomen, extremities, and genitals.
• Palpation is the process of touching and feeling the patient’s body for any abnormalities or changes in texture, temperature, moisture, shape, size, consistency, tenderness, or pulsation. Palpation can be done with one or both hands, using different parts of the fingers or palms. Palpation can provide information about the skin, subcutaneous tissues, muscles, bones, joints, lymph nodes, organs, and vessels.
• Percussion is the process of tapping on the patient’s body with the fingers or a small hammer to elicit sounds or vibrations that reflect the density of the underlying structures. Percussion can be done directly on the skin or indirectly through a finger or a pleximeter. Percussion can reveal information about the size, shape, position, and borders of organs, as well as the presence of fluid, air, or masses.
• Auscultation is the process of listening to the sounds produced by the patient’s body with a stethoscope or an electronic device. Auscultation can detect sounds from the heart, lungs, blood vessels, abdomen, and other organs. Auscultation can provide information about the rate, rhythm, intensity, pitch, quality, and duration of sounds.

These techniques are usually performed in this order when examining each body system. However, some variations may occur depending on the patient’s condition and preference. For example, auscultation may be done before percussion in some cases to avoid altering the sounds such as in abdominal examination.

To perform a physical examination effectively and accurately, health care professionals need to have adequate training and practice. They also need to have good communication skills and cultural sensitivity to establish rapport and trust with the patient. They need to explain the purpose and procedure of each technique and obtain informed consent from the patient. They need to respect the patient’s privacy and dignity and use appropriate draping techniques. They need to document their findings clearly and concisely using standard terminology.

One of the ways that health care professionals can improve their physical examination skills is by attending a five-day patient assessment skills workshop offered by Practitioner Development UK (PDUK). This workshop provides practitioners with a springboard for diagnostic proficiency and clinical decision making. After studying basic history taking and physical examination techniques, participants will have the opportunity to perform a complete physical examination reflecting clinical practice requirements and helping to develop all-round confidence. The course mainly focuses on the adult patient, general history taking and systematic physical examination. Further expertise is developed in the workplace with an appropriate facilitator who can then look at areas that are specific to individual practice. 

Completion of this course does not qualify the attendee as an advanced practitioner but is the first step in expanding practice, leading to a more autonomous role.  

In conclusion, physical examination is a vital skill for health care professionals that can help them provide quality and safe patient care. However, physical examination also requires proper knowledge, technique, and practice. Health care professionals can enhance their physical examination skills by attending a five-day patient assessment skills workshop offered by PDUK.

References:

Bickley, L. S., & Szilagyi, P. G. (2023). Bates’ guide to physical examination and history taking (13th ed.). Wolters Kluwer