Physical examination performed by psychiatrists

UNLABELLED: Too little, too late? Physical examinations performed by trainee psychiatrists on newly admitted psychiatric patients. OBJECTIVES: To assess the comprehensiveness of the physical examination carried out by psychiatric trainees on acute in-patient units. To quantify delays in undertaking physical examination on psychiatric inpatients. METHOD: A prospective case note study of 60 consecutive admissions to acute psychiatric wards in North Staffordshire. Information regarding demography, details of physical examination and routine blood investigations was collected. RESULTS: The case notes of 60 inpatients were studied. Mean age was 38.7 years and the sex ratio equal. A delay in performing a physical occurred in 17 (28.8%) patients. No explanation for a delay was given in six (10.0%) cases. The mean time to physical examination from admission was 61.8 h (range 0-612 h). The standard of physical examination was variable. The central nervous system (CNS) was reported as 'grossly intact' in six (10.2%) cases with only 34 (57.6%) of patients having a comprehensive CNS examination. CONCLUSIONS: Psychiatric patients are not receiving a comprehensive physical examination. Whilst the patient's ability to co-operate may account for a delay in the examination, it is unlikely to be the reason for the CNS being examined in just half the patients. Opportunities to reduce the physical morbidity associated with mental illness may be being lost. (MJ Psych Clin Pract 2004; 8: 57-60).