Originally posted on Medspace

Think about the last time you had a cough or cold and went to the doctor. Did you have a clinical examination? Did they listen to your chest? If they did, did you take your shirt off or lift it up? Or did they listen through it?

Does it even matter what they do? Should the doctor expose the area properly to perform an examination? Or is it acceptable to examine through clothes?

Let’s take an orthopaedic (bones/muscles/joints) exam, we are usually taught to do 3 things.

Look

You can’t see what you can’t see. Sounds bleeding obvious doesn’t it, but you’d be surprised how many times I see patients who say that they were examined but they never took their clothes off. Even for skin checks!

Now that’s fine if it’s something on your finger. Unless you are wearing gloves, it’s probably already exposed, but what about your back for example? If you have a rash how can the doctor make a diagnosis without even seeing it? What about a bruise or a mark? If you have your clothes on it’ll get missed.

To see something you have to be able to actually see it. With your naked eyes. Not those X-ray specs you won in a box of cereal when you were a kid.

Feel

Part of any physical examination. We are taught to feel, to examine with our hands. To see what a wound or rash or generally just whatever body part feels like. In orthopaedic language that means press prod and poke to see what bit hurts, but the same goes for anything really.

How can you tell what something feels like without actually feeling it? If you are examining through clothes then you just don’t get the texture, or the feel of the problem area.

Move

When you move it what happens. Again for orthopaedic exams this is easy, move the joint, but the same applies to other examinations also. Let’s take a chest exam as an example. How can you assess if somebody has difficulty fulling expanding their lungs if you can’t even see them moving? How can you see if a child is using any extra (accessory) muscles to help them breathe?

Why does this matter?

Evidence shows that insufficient clinical examination is a common cause of medical complaints. By ensuring that we examine patients appropriately we can instil confidence, improve our diagnostic skills and reduce complaints.

Exposing the patient properly also allows us to see what else could be going on. Just ask any doctor and they can probably tell you at least 1 or 2 patients they’ve seen where they’ve lifted their shirt to examination their chest and found skin cancer.

I’m no exception – I’ve seen 2 patients this week alone that when I’ve examined their chests I’ve found skin cancers. One of them a melanoma – generally the worst kind of skin cancer. Neither of the patients knew there was even a problem on their back.

So do yourself and your patients a favour. Do a proper examination, remember all examinations start with looking and expose the patient properly. You may just save their life.

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