The Components of a Routine Physical Examination
The appointment typically begins before the physician enters the room. A medical assistant or nurse will often initiate the process by recording vital signs. These fundamental metrics provide a quick snapshot of basic bodily functions. Height and weight are measured to calculate Body Mass Index (BMI), a screening tool for weight categories that may lead to health problems. Blood pressure is checked using a sphygmomanometer, assessing the force of blood against artery walls; elevated readings can indicate hypertension. Pulse rate, or heart rate, is counted, revealing the number of heartbeats per minute. Respiration rate, or the number of breaths taken per minute, is also observed. Occasionally, body temperature is taken, as a fever can signal an underlying infection or illness.
Following the initial vitals check, the patient is usually asked to change into a medical gown to facilitate a more thorough examination. The physician then enters the room and begins the consultation by taking a detailed medical history. This conversation is a critical diagnostic tool. The doctor will review the patient’s personal medical history, including past illnesses, surgeries, allergies, and current medications or supplements. Family medical history is discussed to assess genetic predispositions to conditions like heart disease, diabetes, or cancer. Lifestyle factors are explored, encompassing diet, exercise habits, sleep patterns, tobacco use, alcohol consumption, and sexual health. This is also the time for patients to voice any specific concerns, such as new symptoms, persistent pains, or changes in overall health.
The hands-on portion of the exam, the physical assessment, follows a systematic head-to-toe approach. It starts with a general observation of the patient’s overall appearance, noting posture, skin condition, and alertness. The head, eyes, ears, nose, and throat (often abbreviated as HEENT) are examined. The physician inspects the head and scalp, checks the pupils for reactivity to light, assesses eye movement, and may use an ophthalmoscope to look at the retina. The ears are examined with an otoscope to visualize the ear canal and tympanic membrane. The nose, throat, and sinuses are inspected for any signs of abnormality or infection.
The cardiac and pulmonary systems are evaluated next. Using a stethoscope, the doctor listens to the heart sounds—the familiar “lub-dub”—checking for murmurs, irregular rhythms, or other aberrant noises. This auscultation is performed in several locations on the chest to hear different valves of the heart. Lung sounds are assessed by listening to the front and back of the chest, instructing the patient to take deep breaths; clear, unobstructed sounds are normal, while wheezing or crackles may suggest respiratory issues.
The abdominal exam involves inspection, auscultation, percussion, and palpation. The abdomen is first observed for shape, scars, or visible pulsations. The stethoscope is used to listen for bowel sounds. Percussion, tapping the abdomen with fingers, helps determine the size and density of organs like the liver. Finally, palpation, gently pressing on different areas of the abdomen, checks for tenderness, pain, or abnormal masses, assessing organs like the liver and spleen.
A neurological assessment checks the function of the nervous system. This includes testing cranial nerves through simple actions like smiling, sticking out the tongue, and shrugging shoulders. Muscle strength, sensation, and reflexes in the arms and legs are evaluated. Balance and coordination may be tested with exercises like walking heel-to-toe or touching a finger to the nose. A dermatological exam involves inspecting the skin, hair, and nails for lesions, growths, rashes, or signs of infection, including potential skin cancers.
For men, a male-specific examination may include a testicular check for lumps, tenderness, or size changes, and a hernia exam, where the patient turns their head and coughs while the doctor feels the scrotum for bulges. The prostate gland may be examined via a digital rectal exam (DRE) to screen for enlargement or abnormalities. For women, a female-specific examination often involves a clinical breast exam to feel for lumps or tissue changes, and a pelvic exam to inspect the vulva, vagina, and cervix, typically including a Pap test to screen for cervical cancer.
Diagnostic Testing and Screening
Based on age, sex, medical history, and risk factors, the physician may order preventive screenings or diagnostic tests. Common tests integrated into a physical can include a complete blood count (CBC) to check for anemia and infection, a metabolic panel to assess kidney function, liver function, and blood sugar levels, and a lipid panel to measure cholesterol. A urinalysis provides information about kidney health and can detect signs of diabetes or infection. For older adults or those with specific risks, an electrocardiogram (EKG) may be performed to record the heart’s electrical activity.
Vaccination status is reviewed, and necessary immunizations, such as the flu shot, tetanus booster, or shingles vaccine, are administered. The appointment culminates in a discussion of the findings. The physician shares their assessment, explains any abnormal results, and makes recommendations for maintaining or improving health. This may involve lifestyle modifications, referrals to specialists, or scheduling follow-up appointments for chronic condition management. A physical exam is a proactive partnership between patient and provider, serving as a foundational element of long-term health maintenance and disease prevention.
Preparing for Your Appointment
Maximizing the benefit of a physical requires preparation from the patient. Compile a list of all current medications, including prescription drugs, over-the-counter medications, and dietary supplements, noting their dosages. Create a personal medical history timeline of major illnesses, surgeries, and hospitalizations. Research and document family health history for parents, siblings, and grandparents. Write down any specific health concerns, questions, or symptoms, no matter how minor they may seem; note the onset, duration, and characteristics of any symptoms. Be prepared to discuss lifestyle habits honestly, including diet, exercise, stress levels, and use of tobacco, alcohol, or other substances. Consider bringing previous medical records if seeing a new doctor for the first time.
Understanding the Variations: Well-Child Visits, Sports Physicals, and Medicare Annual Wellness Visits
The structure and focus of a physical exam can vary significantly depending on its purpose. A well-child visit is a comprehensive check-up focused on growth and development. It includes tracking growth curves on percentile charts, administering age-appropriate vaccinations, and conducting developmental screenings to assess milestones in areas like speech, motor skills, and social behavior. Behavioral and learning assessments are also common.
A sports physical, or pre-participation physical examination (PPE), has a narrower focus: determining whether it is safe for an individual to participate in a specific sport. It emphasizes assessing musculoskeletal health, evaluating flexibility, joint stability, and strength, and screening for cardiac issues that could be exacerbated by intense exercise, such as a family history of sudden cardiac death or personal history of heart murmurs.
For individuals aged 65 and older enrolled in Medicare, the Annual Wellness Visit (AWV) is a specific type of appointment distinct from a “routine physical.” It is less about a hands-on physical assessment and more focused on health planning and prevention. The visit involves completing a Health Risk Assessment questionnaire, creating or updating a personalized prevention plan, and screening for cognitive impairment and risk factors for depression.