The dogged physical examination in the era of the C.A.T.

In attempting to evaluate the usefulness of the screening physical examination, it is necessary to remember that these recommendations are for asymptomatic individuals. When specific symptoms are present they need to be evaluated using physical examination and laboratory techniques that are appropriate to diagnosis. Although some of the same examination techniques are applicable for diagnostic evaluation, the goals, techniques, and interpretation of results are frequently different. One must also be aware of the past history of the patient, which may suggest specific risk factors even in the absence of current symptoms. A past history of breast cancer, for instance, might increase the intensity and scope of the physical examination. A history of alcohol consumption might turn an optimal mouth and throat examination into a diligent search. Additional elements of the physical examination may be pertinent to special high-risk groups. For instance, a mental status examination might be part of the routine examination for the elderly. Finally, it is important to remember that the findings on routine physical examination may themselves alter what should be done during the rest of the examination. For example, the finding of high blood pressure requires a search for arterial narrowing, coarctation, and renal bruits. Positive findings on a screening physical examination must always be supplemented by physical examination techniques designed for specific diagnosis. The recommended elements for a screening physical examination are an attempt to assemble reasonable conclusions based on current clinical use. They do not deal with the question of how frequently routine screening should be done. These recommendations need to be adjusted to the needs and views of each individual physician. One cannot help but be impressed by the medical, social, economic, and technical advantages of the physical examination. Although not a perfect technology, it serves important clinical functions in diagnosis and screening for the 1980s. The physical examination, like the human memory, will not be displaced easily even in this era of the C.A.T. scan, the radioimmunoassay, or the nuclear angiogram.