substitute for the actual experi-ence of conducting a competent physical exam, and that’s as true for patients as it is for their healthcare professional. The most effective physical examina-tion is guided by the patient’s history of the complaint and a structured approach to docu-menting the findings. This means you have a ‘form’ -be it paper or digital – which is custom-made for you. Set up your form to re-flect how you systematically ap-proach the exam process. It can be organized by region – anatomic or functional. Or by the sequence you use – standing, sitting, prone and then supine. Or by the general categories which must be included as essen-tial elements of all physical ex-aminations. Remember, when using the SOAP-note method, document physical examination findings under the heading of O – Objective. Objective tests are observable, measurable, repro-ducible, reliable (both intra and inter-examiner), sensitive and specific to the parameters you want to measure. and condition of the tissues. -Evaluate temperature and turgor and tender points. Range of Motion -Screen for restric-tions in active range of motion of a joint. If they are full and pain-free in all possible planes, then you’re done. Any limitations require a closer look. -Passively assess the integrity of non-contractile elements and the quality of joint play. Neurological -Resisted action (muscle testing) is per-formed at the midway point of a joint’s range. -Testing reflexes (cutaneous and deep tendon) and evaluating the distribution of sensory changes are helpful tools for pinpointing pathologies. Special Tests -Challenging specific tissues is a logical way to differentiate various orthopedic and neurovascular problems. Over the years many tests have been devised by people who’s name is now attached. There are several online re-sources for reference. 3 4 5 6 1984 CANADA HEALTH ACT CAME INTO EFFECT THE COMPLETE PHYSICAL EXAMINATION Observations -Note the symmetry of form and motion, the power and rhythm of their gait, the tone of their pos-ture. -Inspect the skin for abnor-malities of pigmentation and texture and integrity. Palpation -Visualize the anat-omy under your hands, appreciate the contours and size 1 2 Vitals -Heart rate, breath-ing rate, blood pressure, body temperature, height/weight/BMI, auscultation of heart sounds, lung fields and abdominal quadrants, percus-sion of chest/abdomen. All of these parameters of a patient’s physical condition are readily assessed if you have the right tools on hand – a sphygmomanometer and stetho-scope, a thermometer, a timer and weight/height scale. Throw in a reflex hammer, a pointy pinwheel and a goniometer and you are good to go. Recording the findings of a physical examination is facili-tated by that consciously con-structed form you employ. Paper or electronic records can consist of text entries, drawing on body diagrams, checklists, grading scales (numeric or mild/moder-ate/severe), +/-/within normal limits entries and, last but not least, the highly efficient Maigne diagram for charting ROM’s. If you don’t already do it, con-sider performing physical exam-inations with a ‘thinking out loud’ approach. It is a good habit to let your patients know what you’re looking for and what you’re finding. Be sure to encourage their questions and listen carefully for clues to their unique situation. And don’t forget that primary care physicians are not expected to successfully treat every condi-tion which presents. The point of primary care is to figure out what’s next. Patients want to know what’s going on, should they be worried, what can they expect, what can be done and can you help them? We have the training to discern the functional from the patholog-ical.We can inform and reassure and make recommendations on further investigations or the best path to resolution of their trou-bles. So be the best you can be at those physical examinations.Use your talented hands, educated brain and curious, caring heart to everyone’s advantage. No health profession has a monopoly on these things. There are fewer and fewer hands-on encounters and that’s where we come in. www.Cndoctor.ca REFERENCES 1. Squandering Billions: Health Care in Canada (Bannerman & Nixdorf Hancock House 2005) 2. Physical Examination of the Spine and Extremities (Hoppenfeld Appleton-Century-Crofts 1976) 3. Clinical Record Keeping: A Hands-On Approach (Armstrong, D. – Online Course – see details at auroraeducationservices.ca July/August 2022 Chiropractic and Naturopathic Doctor 21
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