A physical lesson for the clinicians?

In 2002, a colleague (P. Jeyapaul) and I conducted an audit on physical examination in psychiatric practice while we were working as senior house officers in a teaching hospital. The standard for the audit was that every patient should have received a basic physical examination within 72 h of admission. Of the 78 patients included in the audit, 17 (22%) received a complete examination and 27 (35%) were not examined at all. Of those who were not examined, 9 did not consent and 2 were agitated; no reason was given for the failure to examine the others. The remaining 34 (43%) received an incomplete examination, the most neglected area being the central nervous system. Out of the 78 patients, the records of only 1 mentioned that the skin was examined for evidence of self-harm and substance misuse.

Garden's (2005) article rightly stresses the need to keep up to date with these basic skills and the different areas of focus in the physical examination and their relevance to psychiatric disorders.