What are the most common mistakes made during physical examination?
Brian Garibaldi, MD: I think that probably the most common mistake is not doing the exam at all or doing an inappropriate examination. That is probably the most common mistake.
I would say one of the biggest errors that I see is a failure to uncover the part of the body that is being examined. We have a term for this that I like to use, “stethoscope fishing,” where someone wants to examine a chest and they just open up a top button of the gown and drop the stethoscope in, swing it around, and hope to catch the heart. When you do that, you are missing all the other information that is available as part of the cardiovascular examination. But you are also very likely to miss simple things like the presence of a pacemaker or a scar that suggests that there has been a sternotomy previously.
So, I’d say number 1 is the failure to do the exam; that is the biggest mistake. And number 2 is a failure to appropriately examine a part of the body without clothes on. This also means that you have to know how to drape patients appropriately. There are certain parts of the body, particularly for the general urinary exam or the breast exam, where there is a way to drape the patients such that you can perform the appropriate parts of the maneuver, respect the patient’s modesty, and get the information that you need from that maneuver.