Riegelman R K
Prim Care. 1980 Dec;7(4):625-35.
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.
在试图评估筛查性体格检查的效用时，有必要记住这些建议是针对无症状个体的。当出现特定症状时，需要使用适合诊断的体格检查和实验室技术对其进行评估。尽管一些相同的检查技术适用于诊断评估，但目标、技术和结果解读往往不同。还必须了解患者的既往史，即使当前没有症状，既往史也可能提示特定的风险因素。例如，乳腺癌既往史可能会增加体格检查的强度和范围。饮酒史可能会使原本最佳的口腔和咽喉检查变得更加仔细。体格检查的其他项目可能与特殊高危人群相关。例如，精神状态检查可能是老年人常规检查的一部分。最后，重要的是要记住，常规体格检查的结果本身可能会改变检查其余部分应进行的操作。例如，发现高血压需要检查是否存在动脉狭窄、主动脉缩窄和肾血管杂音。筛查性体格检查的阳性结果必须始终辅以针对特定诊断的体格检查技术。推荐的筛查性体格检查项目是基于当前临床应用试图得出合理结论。它们没有涉及常规筛查应该多久进行一次的问题。这些建议需要根据每位医生的需求和观点进行调整。人们不禁会对体格检查的医学、社会、经济和技术优势留下深刻印象。尽管它不是一项完美的技术，但在20世纪80年代的诊断和筛查中，它发挥着重要的临床作用。体格检查，就像人类的记忆一样，即使在这个有计算机断层扫描、放射免疫测定或核血管造影的时代，也不会轻易被取代。
