Physical examination

A physical examination is a clinical process used by medical practitioners to identify signs or symptoms of a medical condition.

This procedure is essential for determining a diagnosis, which is the identification of a specific disease or condition. Once the provider gathers data, they devise a treatment plan to help the patient. All findings from the examination are recorded in a medical record for future use. This process is a fundamental part of most healthcare encounters, whether a patient is feeling ill or simply seeking a checkup.

The mechanism of a physical exam follows a specific sequence of steps. It typically begins with a medical history, where the provider asks questions about the patient's past and current health. This is followed by an examination based on those reported symptoms. During the physical part, the practitioner uses their senses of sight, hearing, touch, and sometimes smell to gather data. There are four core actions taught as the basis of this work. Inspection involves looking closely at the body. Palpation means using the hands to feel certain areas. Percussion involves tapping the body to determine resonance characteristics. Finally, auscultation is the act of listening to internal sounds, often using a stethoscope.

Medical examinations can be categorized into several distinct types based on their purpose. A routine physical, also called a preventive health examination, is performed on an asymptomatic patient. This means the person does not currently show any signs of illness. These are often used for medical screening to detect early signs of disease. Another type is the pre-employment examination, which is a screening test used to judge a worker's suitability for hire. Some employers use these to reduce workplace injuries or sickness. There are also comprehensive physical exams, sometimes called executive physicals. These are much more detailed and may include laboratory tests, chest X-rays, or heart stress tests.

The history of periodic medical examinations is quite long, though its exact roots are not entirely clear. They have been referenced in records as early as 1671. During the 1920s, many people began to advocate for these regular checks. In the 19th and early 20th centuries, there were pleas for early detection of diseases like tuberculosis. Schools also began using periodic health examinations during this time.

The rise of medical insurance and commercial influences also helped promote the regular physical exam. However, the practice has become a subject of controversy in the modern age of evidence-based medicine.

The significance of routine physicals is a topic of intense scientific debate. A meta-study by the Cochrane Collaboration found that routine annual physicals did not measurably reduce the risk of illness or death. In fact, these exams could lead to overdiagnosis or over-treatment. Overdiagnosis occurs when a condition is identified that would not have caused harm. There is also the risk of "false positives," where a test suggests a problem that does not actually exist. This can lead to unnecessary anxiety or even harm from follow-up procedures. However, a systematic review showed that these examinations can result in better delivery of other screenings, such as cholesterol or cervical cancer tests.

Different parts of the world have different approaches to these exams. In the United States and Japan, the routine physical is very common. In Japan, the law actually requires regular working employees to have a health check once a year. In contrast, the practice varies across mainland European countries and South East Asia. Some organizations, like the American Cancer Society, recommend specific schedules. For example, they recommend annual cancer-related check-ups for men and women older than 40. For those between 20 and 40, they suggest a check-up every three years.

Physical examinations also play a major role in the social aspect of medicine. The exam is often described as a ritual that helps build the doctor-patient relationship. When a patient expects an exam but does not receive one, they may feel the doctor is not investigating their illness deeply enough. This can affect how much the patient trusts the treatment plan. Beyond human health, the term "health check" is even used in other fields. It can refer to checking the working of equipment or the financial solvency of a business. This shows how the concept of a systematic review is used to ensure stability in many different systems.