I have been working in psychiatry (and neurology - an older discipline in
German medicine which combined both fields, neurology being a rather
physical discipline) since 1985 and am a bit shocked to read that even
those doctors working in internal medicine lack the fundamental skills of
physical examination. I want to remind everybody that these skills are
necessary for psychiatrists, too. It is often forgotten that psychiatric
symptoms are 'just' symptoms that there is an imbalance.
Patients have been
sent to me from other doctors (internal intensive units included) as being
psychotic or suffering from a decompensated anxiety disorder, and a skilled
physical examination showed signs of a pneumothorax, pneumonia, open trauma which did not (yet) bleed
because of stress, ileus, heart attacks, strokes, post seizure
semiconsciousness or aura, hypothyroidism or more often hyperthyroidism, cancer,
urogenital infections, brain tumors, etc. Any infection can cause a so
called septic encephalopathia. At least I have seen people who appeared
disoriented and lost who recovered after treating, for example, cystitis. Without
a thoroughly physical examination by the then (after referral) responsible
psychiatrist many of those patients would have suffered worse or even
died.
Rapid Response:
Re: In praise of the physical examination
Not a rapid but nevertheless a response.
I have been working in psychiatry (and neurology - an older discipline in
German medicine which combined both fields, neurology being a rather
physical discipline) since 1985 and am a bit shocked to read that even
those doctors working in internal medicine lack the fundamental skills of
physical examination. I want to remind everybody that these skills are
necessary for psychiatrists, too. It is often forgotten that psychiatric
symptoms are 'just' symptoms that there is an imbalance.
Patients have been
sent to me from other doctors (internal intensive units included) as being
psychotic or suffering from a decompensated anxiety disorder, and a skilled
physical examination showed signs of a pneumothorax, pneumonia, open trauma which did not (yet) bleed
because of stress, ileus, heart attacks, strokes, post seizure
semiconsciousness or aura, hypothyroidism or more often hyperthyroidism, cancer,
urogenital infections, brain tumors, etc. Any infection can cause a so
called septic encephalopathia. At least I have seen people who appeared
disoriented and lost who recovered after treating, for example, cystitis. Without
a thoroughly physical examination by the then (after referral) responsible
psychiatrist many of those patients would have suffered worse or even
died.
Competing interests:
None declared
Competing interests: No competing interests