Medical Examination at the gp's Surgery

Patients in need of medical treatment usually go to see their family doctor in his consulting room or surgery. As a rule, they have to wait in the waiting room.

In order to make the patient's diagnosis, the GP must first learn about the common symptom and the patient's chief complaint. He will want to know if the patient is running a temperature, and if so, he will take it.

Apart from attacks of fever, the most common symptoms include: sweating, general body ache, headache, muscle or joint ache, nausea, diarrhoea, constipation and breathlessness. The patient may also complain of sore throat, cough, weakness, tremor and pain.

On examination, the doctor may find rash, swelling, distention or tumor. The objective findings called signs also include the results of laboratory examinations of the blood, sputum, urine and stools and possibly the cerebrospinal fluid.

The blood sedimentation rate (BSR or ESR -erythrocyte sedimentation rate) and blood count, simple or differential, are important guides for the establishment of a reliable diagnosis. So is the examination of the sputum for bacilli of tuberculosis, pneumococci, staphylococci, pus or blood.

The urine is analyzed for the presence or exact proportion of albumin, sugar, acetone, blood, bilirubin as well as for colour, specific gravity and total quantity per 24 hours. The stools have to be examined for consistency and colour and again for the presence of blood, parasites and fat.

In order to obtain a clear clinical picture, the doctor may want to have the patient X-rayed, or to have him undergo an ECG (electrocardiographic) or EEG (electroencephalographic) investigation. He may want to have his gastric juices analyzed, bronchoscopy, proctoscopy, cystoscopy etc. performed.

In his surgery, the GP uses the four classical methods of:

inspection - to ascertain visible signs of the patient's condition;

palpation - to feel tumour, swelling, distention, the presence of tenderness etc;

percussion - by tapping the chest or other parts of the body and listening

auscultation - to hear chest sounds, irregularity of heart beat, peristaltic sounds in the abdominal cavity etc.

In examining the patient, the doctor proceeds, as a rule, from the top of the head down the neck, to the chest and abdomen, and finally to the extremities.

This - together with the patient's past history and family history – helps to establish a reliable diagnosis and to determine the kind of treatment. Then, the GP writes out a prescription, to recommend bed rest or hospitalization or to refer him to a specialist.

Task 2. Answer the questions:

1. Where do patients in need of medical treatment usually go?

2. What must the GP learn about?

3. What are the most common symptoms of a disease?

4. What can the doctor find on examination?

5. What are important guides for the establishment of a reliable diagnosis?

6. Why may the doctor want to have the patient X-rayed?

7. How does the doctor usually proceed in examining the patient?

8. What helps to establish a reliable diagnosis?

9. What can the GP recommend?

10. Which method deals with chest sounds?

11. What methods of examination do you know?