Routine Physical Examinations

Your doctor uses the routine physical examination to assess your current physical condition and to identify any undiagnosed disorders. A routine physical examination also helps your doctor become familiar with you and your health risks or medical problems. The frequency with which you see the doctor for a routine checkup varies, depending upon your age and whether you already have a medical condition. Before beginning the examination, the doctor will take a complete medical history by asking you a series of questions about your lifestyle habits, general health, and family health history (see page 80). Taking a thorough medical history often takes as long as the physical examination itself but is just as important.

When you go to the doctor's office for a routine physical examination, a nurse or other healthcare worker will weigh you and take your temperature to find out if you have a fever, which could signal an infection. He or she also will take your blood pressure, using an inflatable cuff, pressure gauge, and stethoscope. A blood pressure reading measures how forcefully your circulating blood pushes against the walls of the blood vessels with each contraction of your heart. The reading records the pressure in the vessels both when the heart pumps blood (the systolic pressure) and when it rests (the diastolic pressure). The reading is expressed in two numbers in millimeters of mercury (mmHg)—for example, 120/80 mmHg, which is a reading within the normal range. The first number indicates the systolic pressure; the second number, the diastolic pressure. The higher the pressure in your blood vessels, the higher the reading.

You will be asked to undress and put on a cloth or paper gown. The doctor will begin by examining your skin, checking for any paleness, flushing, yellowish or bluish cast, rashes, dryness, bruising, or broken capillaries (tiny blood vessels). He or she will examine your face, which can display a number of unusual signs, such as puffy eyes, and your neck, checking for swollen glands or an enlarged thyroid (a gland just below your larynx—your voice box—that has an important role in controlling the chemical processes in your body).

Next, your doctor will look inside your mouth with a small flashlight and a 87

tongue depressor to examine your tongue, teeth, and gums. The condition of Preventive your mouth can reveal a number of clues about your general health. For example, Healthcare red, cracking areas on your lips can signal a vitamin B deficiency. The doctor also will check your throat as far back as possible. By using an illuminated instrument called an ophthalmoscope, he or she will look into your eyes to see the retina lining the back of your eyes. Another lighted instrument, known as an otoscope, helps your doctor peer into your ears, to check for any inflammation or a possible perforation of the eardrum.

Listening to your chest with a stethoscope allows your doctor to assess not only the nature of your heartbeat but also the condition of your lungs. Any abnormal heart sounds will alert your doctor to the possibility of an enlarged heart, poor blood flow through the heart, or a disorder of the heart valves. When listening to your breathing with the stethoscope, the doctor listens for wheezing, crackling, or other sounds that could signal the presence of a lung disorder such as asthma. The doctor will probably also tap your chest and place his or her hands against your chest and ask you to cough so he or she can detect any fluid in the chest. This process is called percussion. Taking your pulse is an important part of the examination because your heart rate can reveal heart or circulation problems.

The doctor will want to examine your abdomen, feeling and tapping it to detect any tenderness, abnormal masses, or fluid accumulation. He or she will continue to press on different parts of your abdomen and ask you to respond if you feel any tender areas. The doctor is also checking for the correct positioning of the spleen and the liver. As part of his or her examination of your digestive system, the doctor will probably perform a rectal examination. Your doctor will first cover his or her hands with disposable plastic gloves and lubricate the area to be examined with a cream or jelly. The doctor will gently and carefully place his or her fingers inside your rectum to feel for any tumors in the rectum or prostate. Many prostate tumors are first detected in this way.

If the doctor notices any signs that indicate that you may have a disorder of the nervous system, he or she will assess your motor ability, or ability to move, by observing the way you walk. He or she may also ask you to move your arms and legs in various ways to see whether there is a difference in movement between the two sides of your body. Testing the reflexes at your wrists, knees, ankles, and soles of your feet will also tell your doctor important information about the proper functioning of your nervous system.

To complete the physical examination, the doctor may order blood, urine, stool, or other tests (see next page) to help detect any abnormal conditions. Typical blood tests include the complete blood cell count, cholesterol testing, and a blood glucose test. The collected body fluids are sent to a laboratory for

88 analysis. The doctor may also order X rays or other scans, depending on your

Staying condition.

Healthy After your doctor examines you, he or she will write down his or her findings, along with the information obtained during the medical history, in your medical record. The doctor will also write down his or her orders to other healthcare workers in the office about your medications, diet, tests, and recommended treatments. Your medical record serves as a means of communication for all of the doctors, specialists, nurses, therapists, and other healthcare workers who care for you. It is a confidential and legal document maintained by professional records management workers. If you would like to have a copy of your medical record, contact the medical records department of your doctor's office or hospital.

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