Why do you believe it’s important to conduct a physical examination?
“I get a lot of complaints from patients saying some doctors only talk to them from the doorway, and that they don’t get enough time to ask questions,” Neel said. “When I went to medical school, they harped over and over again that you need to touch the patient. I check eyes, ears, nose, throat, heart and lungs just out of habit. I don’t want somebody to walk out of here with something obvious that went unnoticed.
“I’ve had several patients who had seen multiple doctors who never felt their abdomen to see if their spleen was enlarged. They ran all kinds of test, but failed to do the basic lab tests and physical examinations.”
What are some of the “soft signs” you look for when examining a patient?
In a physical examination, they also look for a lot of “soft signs” that can sometimes tell you more than a rapid strep or flu test.
“I was always taught to treat the patient, not the lab work. There are a lot of false negatives with these rapid tests that we run for the strep or the flu. So there are a lot of soft signs that we look for—the strawberry tongue or the perioral pallor, for example—which both indicate strep.
“When you listen to someone’s lungs using a stethoscope, you can listen for what’s called E to A changes. The patient says E over and over—and if it sounds like they said A—that could be a result of fluid in the lungs, indicating pneumonia.
“Every time I look at someone I notice their skin color….Yellow/greenish skin, or jaundice, can indicate liver problems, and a gray, ashy look indicates poor circulation, due to issues with the heart or lungs. If someone is really pale, they could be anemic.
“Those are just a few of the things I look for. I’m always looking for those kinds of things when I walk into a restaurant or room full of people, without even realizing it sometimes.”