The Importance of a Hands-on Physical Exam

It is no secret that I (and other experts agree) that a diagnosis is 90% history, if a thorough history has been taken. However, that 10% can be the life changing action needed in your case. During a physical exam the Nurse Practitioner (NP) takes the patient back to the room, this means the initial exam begins at “Hello”.  With no middle person, the NP observes gait, voice, body position and mannerisms from the start.  After the history is taken the real physical exam begins.  From your head down to your toes we are searching.  Searching for clues that can tell us about acute symptoms, chronic illnesses or benign anomalies.  Is the “simple urinary tract infection” just that or a new ovarian mass or perhaps renal cancer (those are real diagnoses that we have seen) just from what was stated as a “simple” urinary tract infection by the patients making the appointment.    Are the white spots or ridging of your nails just bad luck or a vitamin deficiency?  Is the mild shortness of breath you feel the heart, the lungs or mild anxiety?  Is the mild abdominal discomfort normal?   Is your brain fog just a passing event?

Obtaining accurate vital signs, being able to perform a neurologic exam, palpating the abdomen, listening to the heart and lung and visualize the skin, tongue, nails and hair are big clues in to the body’s function and should not be forgotten.    Being able to see the whole person and not just the part on camera can make a difference.  A complete Physical Exam done properly is still key in prevention and diagnosis.