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Physical examination in psychiatric practice

  • Gill Garden

Physical disease is more prevalent in people with mental disorder than in the general population. It is important for psychiatrists to maintain skills in physical examination to ensure that physical illness is diagnosed and treated appropriately. A sound knowledge of medical illness ensures that examination is targeted at the relevant diseases. Mental health units should provide adequate facilities and equipment. All detailed examinations should be undertaken in the presence of a chaperone. Opportunities for psychiatrists to refresh their knowledge and skill are suggested.

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BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
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Physical examination in psychiatric practice

  • Gill Garden
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Audit on Physical examination in Psychiatric practice

Pavan S Chahl, Locum Staff Grade Psychiatrist
01 June 2005

With reference to the article written by Gill Garden: Physical Examination in Psychiatric Practice (Advances in Psychiatric Treatment-2005, 11:142-149), I report an audit conducted with a colleague of mine DrP Jeyapaul on the physical examination in psychiatric practice. This was completed in 2002 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 hrs of admission. 78 patients were included. A complete examination was done for 21% and 34% did not receive one. No reason was given for a majority of the patients who did not receive a physical, 9 patients did not consent and 2 were agitated.

The remaining 43% received an incomplete examination, the most neglected area being the central nervous system. Out of the 78 patients there was a mention of the skin being examined for evidence of deliberate self-harm and substance abuse in only one patient.

The article rightly highlights the need for keeping up to date with these basic skills and different areas of focus in the physical exam and their relevance to psychiatric disorders.
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Conflict of interest: None Declared

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Medical Training for Psychiatrists

Satnam S. Kunar, Staff Grade in psychiatry
27 April 2005

Dr. Alan Lee,Royal College of Psychiatrists,17, Belgrave Square,London.SW1X 8PG.

Dear Dr.Lee,

In response to the article by Dr. Gill Garden (Garden, 2005) on physical examinations in psychiatric practice, it is important to highlight some of the problems that trainees in psychiatry frequently comeacross.

I certainly applaud the increase in awareness of the Royal College ofPsychiatrists in physical illnesses and the importance in detecting these,but I fear that the level of teaching that Juniors undergo for this is extremely poor. Indeed, having come through a large SHO rotational scheme,I cannot recall a single lecture that was devoted to carrying out a physical examination and yet this is now an essential component of the OSCE in the Part 1 exam. Even in Part 2, as many marks are set aside for the physical examination as for the mental state examination.

Working in a field such as Rehabilitation Psychiatry, physical problems are even more important due to the fact that patients are often on high doses of medication (as well as the problems of polypharmacy), areusually older and less physically active than their younger counterparts. Fortunately at Warwick, we do have a local GP who has two allocated sessions per week to deal with any physical problems on the Rehabilitationwards and this shared care approach, similar to that described by Dr. Lester (Lester, 2005), is one that is valued by both our patients and staff. It also ensures that long-term psychiatric patients receive adequate screening.

With new guidelines constantly being issued on the checks we should be performing on patients taking psychotropics and the ever-present threatof medico-legal implications, I feel it is high time that more emphasis inour training was placed on physical examinations with regular “refresher” courses even after membership, similar to the Advanced Life Support courses. This also has to involve psychiatric nursing staff who usually have only basic “physical” training and so perhaps the Nursing Midwifery Council and the Royal College of Psychiatrists should jointly look into this. A combination of the shared care approach between primary and secondary services and an increased emphasis on teaching psychiatrists andpsychiatric nurses about physical illnesses is, in my opinion, the best way to looking after the holistic well being of our patients.

By the way, for those of you who always wanted to know how to calculate the QTc interval but were afraid to ask, I managed to find this formula in one of my medical textbooks:

QTc = QT interval divided by the square root of the R to R interval

… you just have to know how to read an ECG now!


Garden, G. (2005) Physical examination in psychiatric practice. Advances in Psychiatric Treatment, 11: 142-149.

Lester, H. (2005) Shared care for people with mental illness: a GP’s perspective. Advances in Psychiatric Treatment,11: 133-139.

Kumar, P. and Clark, M. Clinical Medicine (3rd edition). Bailliere Tindall.

Dr. Satnam Singh Kunar MRCPsych,Staff Grade in Rehabilitation Psychiatry,St. Michael’s Hospital,St. Michael’s Road,Warwick.CV34 5QW.

Telephone: 01926 406727Fax: 01926 406702
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