Physical examination

A physical examination, medical examination, or clinical examination is the process by which a medical practitioner examines the body of a patient for any possible signs or symptoms of a medical condition. It generally consists of a series of questions regarding patient medical history followed by an examination of the symptoms. Together, the medical history and the physical examination aids in determining the correct diagnosis and devising the treatment plan. This data then becomes part of the medical record. The physical examination may be used to investigate a patient's symptoms or complaints or as a routine screening procedure in an asymptomatic patient, in which case it is referred to as a routine physical, general medical examination or check-up. A physical examination, medical examination, or clinical examination is the process by which a medical practitioner examines the body of a patient for any possible signs or symptoms of a medical condition. It generally consists of a series of questions regarding patient medical history followed by an examination of the symptoms. Together, the medical history and the physical examination aids in determining the correct diagnosis and devising the treatment plan. This data then becomes part of the medical record. The physical examination may be used to investigate a patient's symptoms or complaints or as a routine screening procedure in an asymptomatic patient, in which case it is referred to as a routine physical, general medical examination or check-up. A Cochrane Collaboration meta-study found that routine annual physicals did not measurably reduce the risk of illness or death, and conversely, could lead to over-diagnosis and over-treatment. However, this article does not conclude that being in regular communication with a doctor is not important, simply that an actual physical examination may not be necessary. The routine physical, also known as general medical examination, periodic health evaluation, annual physical, comprehensive medical exam, general health check, preventive health examination, medical check-up, or simply medical, is a physical examination performed on an asymptomatic patient for medical screening purposes. These are normally performed by a pediatrician, family practice physician, physician assistant, a certified nurse practitioner or other primary care provider. This routine physical exam usually includes the HEENT evaluation. Nursing professionals such as Registered Nurse, Licensed Practical Nurses can develop a baseline assessment to identify normal versus abnormal findings. These are reported to the primary care provider. If necessary, the patient may be sent to a medical specialist for further, more detailed examinations. 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. Although annual medical examinations are a routine practice in several countries, unspecified examinations are poorly supported by scientific evidence in the majority of the population. A 2012 Cochrane review did not find any benefit with respect to the risk of death or poor outcomes related to disease in those who received them. People who undergo yearly medical exams however are more likely to be diagnosed with medical problems. Some notable general health organisations recommend against annual examinations, and propose a frequency adapted to age and previous exmination results (risk factors). 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. The effects of annual check-ups on overall costs, patient disability and mortality, 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 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 doesn’t 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.