Intended for healthcare professionals

Rapid response to:

Editorials Christmas 2009

In praise of the physical examination

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b5448 (Published 16 December 2009) Cite this as: BMJ 2009;339:b5448

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

27 January 2010
Roswitha Goetze-Pelka
retired, student of Translational Medicine
IV20 1XH