A medical history is the most important part of the physical examination, especially during the first visit with your physician. It includes a history of habits, lifestyle, family history, and symptoms. Many physicians use health-risk appraisals, detailed questionnaires that provide information about health habits.

This is one area of the physical examination for which a patient can prepare. By following the guidelines for communicating with your physician presented earlier in this chapter, you can help your physician obtain an accurate health profile. This is important because a diagnosis can usually be made with only a thorough history and hands-on examination.

The hands-on examination is the second part of the physical examination. It consists of an examination by touching, looking, and listening.

Physicians can feel or palpate for enlarged glands, growths, and tumors with procedures, such as the breast examination, pelvic examination, rectal examination, and hernia examination. Thumping the back and chest lets the physician know whether any fluid has built up in or around the lungs. Tapping a knee for reflexes may reveal nervous system damage. A stethoscope is the physician's basic listening device and is used to listen to the heart, lungs, abdomen, and glands located near the surface of the skin. Possible problems that can be detected with the stethoscope range from a heart murmur to such conditions as poor circulation, lung infection, intestinal blockage, and an overactive thyroid gland.

Physicians have access to a number of instruments to visually inspect for problems. An ophthalmoscope is used to view the brain by looking into the eye. The first sign of some brain diseases is an unhealthy looking optic nerve. Leakage in the blood vessels of the eye may be a sign of diabetes or hypertension. An otoscope is used to inspect the ear, particularly the tympanic membrane. The proctoscope and sigmoidoscope are used to examine the rectum and colon. The laryngoscope and bronchoscope provide a look at the larynx and bronchial tubes.

The last part of the physical examination includes diagnostic laboratory tests, which may vary from a simple urinalysis to invasive dye tests. The effectiveness of these tests receives mixed reviews. Tests conducted for specific symptoms may be invaluable in pinpointing disabling conditions. They may be just as valuable for what they do not reveal as they are for what they do reveal. This can be reassuring to the patient and physician.

On the negative side, many physicians rely too heavily on laboratory tests. Patients often demand or acquiesce to more tests than necessary, sometimes more than is good for them. Ten years ago, one fourth of all medical tests contributed little to health. For example, when researchers at the University of California, San Francisco, studied 2000 patients hospitalized for surgery, they found that 60% of the blood tests routinely ordered were unnecessary. Only 1 in about 450 revealed abnormalities, and they were ignored because they were either not noticed or dismissed as not significant. The researchers concluded that if a thorough history turns up no hint of a medical problem, routine testing is a waste.

Many times tests are recommended more for the purpose of protecting the doctor against medical malpractice suits, rather than for their diagnostic value. This practice, which is called defensive medicine, paints a sobering picture of the difficulty in making medical decisions for doctors and patients alike. A doctor may know with 99% certainty a particular diagnosis but order a test or procedure any way as protection against liability should he or she be sued later. Malpractice suits are a reality; they have increased 300% in the past 30 years. Almost two thirds of physicians say that the threat of liability influences them to order extra tests. 28 Of course, patients always have the right to decline a prescribed test. It should be a two-way decision between patient and doctor that is based on its potential for an effective medical intervention.