출처: 자이딥 S. 탈와르,MD, 내과 및 소아과, 예일 의과 대학, 뉴 헤이븐, CT
신체의 검사는 의학의 실천에 기본입니다. 로마 제국 이후, 의사는 신체의 특정 부분과 특정 질병 상태의 기능에 있는 변경 사이 연결을 설명하고 침대 옆 진단을 향상 시키기 위해 추가 과학적 이해를 추구 했다. 그러나, 의료 진단 내의 기술 증가의 이 현대 시대에, 신체 검사가 오늘 하는 역할을 고려하는 것이 중요합니다. 신체 검사가 모든 해답을 가지고 있다고 믿는 것은 잘못 인도되며, 이전에 높은 평가를 받고 있던 특정 작전의 의심스러운 유용성에 대해 많은 것이 기록되었습니다. 신체 검사가 현대 환자 만남에서 거의 역할을하지 않습니다 제안하는 것은 똑같이 잘못 인도됩니다.
신체 검사는 귀중한 진단 도구로 남아 있습니다. 신체 검사에 의해서만 할 수 있는 많은 진단이 있습니다. 실험실 또는 화상 진찰에 의해 만들어진 진단은 침대 측에서 검출할 수 있는 사실 인정의 부재에서 드물게 행해지지 않습니다. 공급자는 역사와 물리적인 것을 지휘하기 때문에, 그(것)들은 환자의 상태를 설명하기 위하여 가설을 능동하게 생성하고 시험하고 있습니다. 수집한 정보는 테스트의 필요성을 대체하지 않을 수 있지만, 확고한 가설을 가지고 있으면 공급자가 테스트를 보다 신중하게 주문하고 이러한 테스트에 대한 더 나은 질문을 할 수 있습니다. 이것은, 차례차례로, 환자에게 리스크를 감소시키고 헬스케어 시스템을 위한 비용을 절약할 수 있는 잠재력을 가지고 있습니다. 마지막으로, 신체 검사는 치료 관계에서 중요한 역할을합니다. 임상의는 신체 검사의 오랜 의식에 참여하여 (관심과 감도를 보여 줌으로써) 교감을 개발하고 고의적이고 책임있는 터치 사용을 통해 치유를 촉진 할 수있는 기회를 제공합니다.
This video demonstrates the role that physical examination plays in the modern patient encounter and has reviewed some critical steps to ensure the exam is carried out in a safe and sensitive manner. Important preparatory steps before the examination help to reduce risk of infection as well as patient and provider anxiety. Ensuring patient privacy and using gowns and drapes in a sensitive manner also makes patients feel more comfortable. A deliberate approach to the examination that is grounded in clinical reasoning is valuable to optimize efficiency and the predictive value of the exam. An organized approach to the maneuvers being performed minimizes the need for unnecessary patient repositioning. The specific maneuvers to be performed vary based on the clinical circumstance, but an examiner's efforts to maintain clear communication with attention to patient comfort should not vary.
The physical examination has played a vital role in patient care for millennia and should continue to do so even in the face of technological advances. Over the past forty years, multiple studies in various clinical settings have demonstrated that history and physical alone allow physicians to arrive at the correct diagnosis a great majority of the time. In almost all other circumstances, the information gained at the bedside allows the clinician to utilize clinical reasoning to judiciously order and interpret tests to make diagnoses. Given the recent emphasis on medical cost containment, patient safety, and access to services, bedside diagnostics remain inexpensive, widely available, and carry little risk of adverse effects.
Physical examination has been fundamental to the practice of medicine for centuries. Despite substantial advancement in medical instrumentation, physical examination remains a valuable diagnostic tool, and its importance cannot be overstated. As physicians assess history and conduct a physical, they gather information leading to a firm hypothesis, which promotes a more judicious approach to ordering tests and analysis of those tests. This, in turn, has the potential to reduce patient risk and health care costs.
This video will illustrate some of the important steps that every physician must take to ensure that the physical exam is carried out in a safe and sensitive manner.
A physical exam can be comprehensive or specific, but the overall steps before and during each exam remain the same. Let’s review these steps in detail.
First, the exam room should be prepared for the patient by disinfecting surfaces to be used during the examination. In addition, a physician should disinfect equipment like the stethoscope or the reflex hammer, which may be used during the exam. Before every exam, wash your hands with soap and water or apply topical disinfectant solution. If the patient is suffering from a known specific infection, then control precautions should be taken by obtaining the necessary protective equipment. Make sure that cuffs of the gloves cover the gown so that no skin is exposed.
Once the patient is seated in the room, knock on the door and ask for patient’s permission to enter the room. Introduce yourself and your role. Request the family members or friends who have accompanied the patient to step out of the room. This provides an important opportunity to speak to the patient alone. Ensure that the exam room curtains are drawn and doors are closed. While talking to the patient, general observations should be made regarding the patient’s health. These include, appearance consistency with the stated age, overall health, alertness, affect, thought content and organization, and perception.
After this initial conversation, determine what aspects of the examination are necessary. Ensure the patient is dressed appropriately for the planned exam. If necessary, provide the patient with a gown and drape and give them some time to change. After some time, knock on the door and ask for the patient’s permission to enter the room. Request the patient to occupy the exam table. Adjust the back of the exam table as needed to optimize your ability to perform maneuvers. The physical examination can be subdivided into the following components: general survey, measuring vital signs, examination of the neurologic functioning and mental status, examination of the head, eyes, ears, nose, throat, chest, lungs, lymph nodes, cardiovascular, abdomen, musculoskeletal, skin, genitourinary, and rectal. A chaperone may be necessary if a sensitive exam like genitourinary, rectal, or breast exams is to be conducted.
Explain the patient the physical exam that is going to be conducted and ask for their permission to proceed with the exam. “Now that I’ve explained what I am going to do, may I proceed with the examination?” Each exam consists of maneuvers employing the techniques of inspection, percussion, palpation, and auscultation, each of which is explored in detail in separate videos of this collection. You should strive to minimize patient repositioning by grouping maneuvers together that need to be performed in a particular position. After the exam is complete, request the patient to change back to regular clothing. It is optimal to wait until the patient is dressed again before offering advice and opinion. Subsequently, weighing how the presence or absence of particular findings affects disease probability and consolidating the information obtained from patient’s history and physical exam, one may decide to initiate a therapy or order additional testing in a deliberate and judicious manner.
You have just watched JoVE’s video on general approach to the physical examination.
This video reviewed the importance of physical examination in the modern patient encounter and demonstrated some critical steps to ensure the exam is carried out in a safe and sensitive manner. Important preparatory steps before the examination help to reduce risk of infection, and an organized approach to the maneuvers being performed minimizes the need for unnecessary patient repositioning.
Given the recent emphasis on medical cost containment, patient safety, and access to services, physical examination remains inexpensive, widely available, and carries little risk of adverse effects. As always, thanks for watching!
