So hopefully before reading this you have already read Part I and Part II and understand why it is so important that you have a health check and what kind of things should have been focused on in the history. Only after a good thorough history has been taken should your Physician move on to the. If someone tries to move directly to this phase of the exam they are missing a lot of vital information.
The physical examination is an art and a good Physician will be able to tell an awful lot about you just by the way you walk into the room. Aside from this general examination there are also a series of focused examinations that should be conducted as part of this health check. Each doctor will have his own sequence for carrying out the physical and the only important thing is that it all gets done. For simplicities sake I will work through it from top to bottom.
A brief screening examination of the head should be carried out to ensure all is in good health. This will involve looking at the
Eyes – a check of visual acuity (using a chart) as well as pupils and general examination
Ears – a check of the tympanic membranes (ear drums) and for any wax or other debris
Mouth – a quick look at the back of the throat and dental hygiene
Cardiovascular – A listen to the heart sounds, usually in a few different places, to ensure that there are no murmurs or other abnormalities. A feel of the pulses can also provide some valuable information.
Respiratory – A listen to the lungs to ensure that all breath sounds are normal and there is no evidence of wheeze, crackles or other issues that could indicate problems. The lung sounds can actually be better accessed from the back so this is why we often listen from behind. Wear easily removable clothing so your doctor can place his stethoscope directly onto the skin, otherwise subtleties can be missed.
Any examination of the stomach should take place with you lying flat on your back in a relaxed position. The important things your doctor will be feeling for are any signs of an enlarged liver (right side), spleen (left side), kidneys (in the flanks), hernias (they may ask you to cough), and general feel of the abdomen
These are the main examinations although your doctor may then move onto more specialized examinations such as neurological, if the history suggested a need.
Part of the examination involves the taking of certain measurements that can be done in the office or in some instances by a nurse before you see the doctor.
Height and Weight
This will allow the doctor to calculate a measurement known as the Body Mass Index (BMI). It is useful as it gives the doctor an indication as to where you stand in comparison to the the population and if you may be overweight or underweight. The BMI has fallen out of favor in the past few years as it is only applicable to certain segments of the population but it is still a useful tool. In general a BMI over 25 indicates someone is overweight and over 30 indicates one is significantly overweight. Obviously if you are very fit with lots of muscle you will have a high BMI although you are not overweight, and this is why it should be interpreted carefully.
This is one of the most well known of measurements and is extremely important. A high blood pressure (hypertension) can significantly increase the risk of cardiovascular disease, kidney disease and stroke and for this reason must be regularly monitored. The diagnosis of high blood pressure is not so straightforward to make and certainly can’t be done on one visit. There are several reasons the blood pressure can go up and visiting the doctors is one of them (you may have heard of ‘white coat syndrome’).
The blood pressure reading is made up of two numbers, the systolic (first or top number) and the diastolic (second or bottom number). The systolic is the top pressure that is reached in the arteries when the heart pumps out blood and the diastolic is the baseline pressure. As a guide if the systolic is persistently above 140 and/or the diastolic is persistently above 90 then you definitely suffer from hypertension and action needs to be taken. For more information read about what causes high blood pressure and how to treat it.
To diagnose someone with high blood pressure we need to confirm several high readings over a period of visits. A more reliable way to diagnose hypertension is by taking several readings at home using a home blood pressure machine. Your doctor can then analyze the results after you have recorded them. In some cases your doctor may organize an ambulatory blood pressure machine to take readings automatically several times throughout the day.
It doesn’t take long for an experienced Physician to carry out all these parts of the physical examination, but it is vitally important that they do. They allow one to form an overall picture of your health and any subtle or gross abnormalities to be identified. Once finished you can then move onto the next and final part of the health check – the ordering of investigations.