The key to a thorough and accurate physical examination is developing a systematic sequence of examination. Organize your comprehensive or focused examination around three general goals:
■ Maximize the patient's comfort.
■ Avoid unnecessary changes in position.
■ Enhance clinical efficiency.
In general, move from "head to toe." Avoid examining the patient's feet, for example, before checking the face or mouth. You will quickly see that some segments of the examination are best assessed when the patient is sitting, such as examination of the head and neck and the thorax and lungs, whereas others are best obtained with the patient supine, such as the cardiovascular and abdominal examinations.
As you review the Techniques of Examination on the following pages, note that clinicians vary in where they place different segments of the examination, especially examinations of the musculoskeletal system and the nervous system. Some of these options are indicated in red in the right-hand column. Suggestions for patient positioning during the different segments of the examination are also indicated in the right-hand column in red.
With practice, you will develop your own sequence of examination, keeping the need for thoroughness and patient comfort in mind. At first, you may need notes to remind you what to look for, but over time, this sequence will become habitual and remind you to return to segments of the examination you may have skipped, helping you to be complete.
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