Examination Methods

EXAMINATION METHODS

INSPECTION

  • Definition: The physician visually inspects the patient to assess their overall health.

    • **Elements of Inspection:

    • Observations: Demeanor, grooming, and social interactions play a crucial role in understanding the patient’s condition.

    • Body Parts Inspected:

      • Interior parts such as throat, eyes, ears, vagina, cervix, and rectum using special instruments.

    • Documentation:

    • Notes are taken regarding any unusual characteristics including:

      • Color

      • Symmetry

      • Size

      • Shape

PALPATION

  • Definition: The method where the physician uses their hands to feel the skin and underlying organs and tissues.

    • Purpose: To determine any unusual tenderness, size, shape, and texture of underlying structures.

    • Detection of:

    • Masses and abnormalities

      • Particularly in the abdomen.

    • Techniques:

    • One-handed palpation

    • Two-handed (deep palpation) method.

    • Additional Areas Assessed:

    • Armpit, neck, and chest.

PERCUSSION

  • Overview: The process of using fingertips to tap the body lightly and sharply to gain information about the underlying body parts.

    • Technique:

    • Place two fingers of one hand on the patient’s skin.

    • Struck using index and middle finger of the other hand.

    • Application:

    • Percussion of the chest wall and abdomen.

      • Produces standard sounds or vibrations that offer diagnostic insights.

    • May help identify the presence of fluid or pus within a cavity.

REFLEX HAMMER

  • Function: Tests the body's reflexes as part of a neurological examination.

  • Technique:

    • The doctor taps the hammer against the tendon reflex located at the bottom of the patella (kneecap).

WARTENBERG WHEEL

  • Description: A medical device used in neurology to test nerve reactions (sensitivity).

  • Inventor: Created by Dr. Robert Wartenberg.

  • Functionality:

    • Features evenly spaced sharp pins that rotate while rolling across the skin, systematically assessing sensitivity.

AUSCULTATION

  • Definition: The process of listening to internal body sounds made by organs such as the heart, lungs, stomach, and bowels.

    • Assessment Criteria:

    • Strength, presence or absence, and rhythm of the sounds.

    • Tools Used:

    • A stethoscope to amplify the sounds, or direct ear placement over the body surface.

MENSURATION

  • Purpose: Measurements taken to obtain a patient’s weight, height, and other body dimensions.

    • Tools Used:

    • Scale for weight

    • Tape measure for height.

    • Other Applications:

    • Measuring size of an infant’s head, chest circumference, or diameter and length of limbs.

    • Weapons used to determine the size of a wound.

GONIOMETER

  • Function: Used to measure the range of motion in a joint, effectively assessing flexibility and mobility.

CALIPERS

  • Description: A measurement tool, either metal or plastic, used to measure the diameter of an object.

    • Application:

    • Skin fold thickness across various body parts, aiding in determining lean body mass.

MANIPULATION

  • Definition: The passive process of evaluating the range of motion in a joint, combining palpation for abnormalities or warmth indicating injury.

    • Context of Use:

    • Commonly used in situations where patients seek to return to work after injury or illness for documentation required by insurance companies.

ASSISTING DURING A PHYSICAL EXAMINATION

  • Roles of Medical Office Assistant (MOA):

    • Position and drape the patient for comfort and access during examination.

    • Provide support for elderly or disabled patients in achieving the required examination position.

    • Hand over various instruments and equipment to the physician as needed.

    • Document and label specimens collected during the examination.

    • Offer reassurance to patients throughout the examination process.

    • Act as a witness to physician and patient interactions - vital in maintaining transparency and trust.

    • Carry out treatment plans, including delivering educational resources to patients.

    • Schedule any diagnostic tests or procedures ordered during the examination.

THE LAW

  • Legal Context:

    • A consent-based contract between doctor and patient exists during a physical examination.

    • The patient provides either expressed or implied consent to physical touch by the physician.

  • Witness Role of MOA:

    • MOAs may be asked to act as witnesses during sensitive examinations, such as gynecological examinations, due to their legal implications.

CULTURAL CONSIDERATIONS

  • Significance: Understanding cultural differences is crucial during physical examinations.

  • Key Points:

    • In certain cultures, only same-sex members may be present during examinations.

    • Husbands may be required to be present during their wives' examination.

    • Every patient's cultural wishes should be respected; concerns regarding these requests should be discreetly discussed with the physician.