Physical examination

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.

[9][10][11] 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.

[13] Disadvantages cited include the time and money that could be saved by targeted screening (health economics argument),[14] 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.

[15][16][17] The lack of good evidence contrasts with population surveys showing that the general public is fond of these examinations, especially when they are free of charge.

[23] The routine physical is commonly performed in the United States and Japan, whereas the practice varies among South East Asia and mainland European countries.

[27] The advent of medical insurance and related commercial influences seems to have promoted the examination, whereas this practice has been subject to controversy in the age of evidence-based medicine.

However, certain exams or tests that are requested by employers, such as a baseline low back x-ray, should not be performed, according to the American College of Occupational and Environmental Medicine.

In the United States, physicals are also marketed to patients as a one-stop health review, avoiding the inconvenience of attending multiple appointments with different healthcare providers.

A Cochrane review found that general health checks did not reduce the risk of death from cancer, heart disease, or any other cause, and could not be proved to affect the patient's likelihood of being admitted to the hospital, becoming disabled, missing work, or needing additional office visits.

The study found no effect on the risk of illness, but did find evidence suggesting that patients subject to routine physicals were diagnosed with hypertension and other chronic conditions at a higher rate than those who were not.

Its authors noted that studies often failed to consider or report possible harmful outcomes (such as unwarranted anxiety or unnecessary follow-up procedures), and concluded that routine health checks were "unlikely to be beneficial" in regards to lowering cardiovascular and cancer morbidity and mortality.

[4] Physical examination has been described as a ritual that plays a significant role in the doctor-patient relationship that will provide benefits in other medical encounters.

Four actions are taught as the basis of physical examination: inspection, palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (listen).

[citation needed] While the format of examination as listed below is largely as taught and expected of students, a specialist will focus on their particular field and the nature of the problem described by the patient.

Likewise an orthopaedic surgeon will examine the affected joint, but may only briefly check the heart sounds and chest to ensure that there is not likely to be any contraindication to surgery raised by the anaesthetist.

With the clues obtained during the history and physical examination the healthcare provider can now formulate a differential diagnosis, a list of potential causes of the symptoms.

[43][44] Physicians at Stanford University medical school have introduced a set of 25 key physical examination skills that were felt to be useful.

The Old Testament makes provision for persons in the Israelite community with leprosy to be examined by a priest: if the presenting sore was white and appeared to go beyond the depth of the skin, it was to be treated as a ritually defiling condition.

A doctor using a stethoscope to listen to a 15-month-old's abdomen
A resident physician at the Granada Relocation Center , examining a patient's throat
A medical doctor examines a young girl, Guinea-Bissau , 1974
A doctor examining a pediatric patient in hospital