From Talking to Examining

By Adam Widdison, author of The Expert Clinician

If you are a healthcare professional (HCP) seeking to update your skills and keep your consultations relevant in today’s rapidly changing healthcare landscape, this blog is for you.

In earlier posts, starting with “The Art of Conversation”, we explored how conversation gathers information and builds trust.

For many patients, information exchange is more than conversation; it is a sensory experience that begins when you first meet the patient and continues throughout the examination.

A well-conducted examination can confirm or refine what is known, reveal unexpected findings, and strengthen the patient’s confidence that they have been thoroughly assessed.

This post explores the role of the examination in the consultation.

Is an examination necessary?

In an era of remote consultations, many encounters never include a physical examination. If you anticipate that one will be needed, arrange a face-to-face visit.

Even in person, not every patient requires an examination. Decide while you are talking with them.

An examination invades personal space. Perform it only when it is likely to add useful information and always with the patient’s consent.

An examination is almost always indicated when the patient has a visible or palpable abnormality (a skin lesion, a swelling, or a joint deformity). It is also worthwhile when it is likely to help answer the questions that matter in this consultation: diagnosis, severity, impact, or management.

Do not examine if the patient declines, or if the situation is unsafe.

Preparation and Consent

While talking to the patient, decide not only whether to examine, but also the aims, and which areas and signs are most relevant. Looking specifically for a sign (or its absence) makes you far more likely to notice it.

When an examination is indicated, you may undertake it only with the patient’s consent, and you should conduct it in a private setting with a chaperone, suitable facilities, and the necessary equipment.

Consent rests on trust. The rapport you’ve built through conversation underpins this trust. Patients need to believe that the examination is necessary and that you will perform it with care, respect, and dignity.

Nervous or self-conscious patients may need more time; sometimes it’s better to defer the examination to a subsequent visit.

Decide on the aims

Never examine as a routine. Let the context and aims of the consultation, the patient, and information learnt from talking to the patient shape the aims of the examination.

For many, the examination plays a crucial role in the consultation, while for others, such as those with visible or palpable abnormalities, it is essential for establishing a diagnosis and planning treatment.

Common purposes include:

Confirming, refining, or excluding a diagnosis.
Locating and characterising the abnormality.
Assessing severity, functional impact, or risk.
Screening for complications or secondary problems.
Guiding management decisions.
Occasionally, demonstrating a finding to the patient or offering reassurance.

These aims can shift as the examination unfolds. For example, the aims of the consultation may be to formulate a diagnosis and plan management, whereas the aims of the examination may be to exclude a sign or to assess the impact of the problem on the patient.

The same examination may serve different purposes for different patients. Examining the abdomen, for instance, may be aimed at diagnosing the cause of abdominal pain in one patient, or checking for hepatomegaly in a patient with melanoma.

Timing and Starting Point

Most patients present with symptoms such as pain or altered function, including a change in bowel habit. In these cases, the examination usually follows the conversation.

When a visible or palpable abnormality is the chief complaint, or when an investigation has already identified a specific abnormality, begin the examination earlier.

Start at the site of the problem. For example, ask a patient with groin swelling to show it, then examine the area first. From there, move to related or systemic signs as the findings dictate. You can ask relevant questions at any time.

Avoid irrelevant examinations. For example, a rectal examination in a patient whose only concern is a breast lump adds nothing and risks undermining trust.

Examination practicalities

Explain what you plan to do and why.

Keep the examination focused and appropriate. Examine with care and compassion, demonstrating respect, sensitivity, and empathy.

Choose the right method for the region and the sign you are seeking: inspection and palpation are key for the limbs, face, neck, back and abdomen; percussion and auscultation for the chest.

Specialists may add instruments, but the principle remains the same: use the technique that best answers the clinical question.

When you find an abnormality, ask two questions:

“What does this mean?”

“What else should I look for?”

Then integrate the findings with everything you already know about the patient.

Examination pitfalls

The accuracy of an examination depends on the patient, the examiner’s skill, and the sign being sought. Some signs are reproducible; others are subjective and show marked inter-observer variation. The more abnormal a finding, the more likely it is to be real.

Confirmation bias is a common trap: we tend to see what we expect and overlook what we do not. If symptoms and signs are consistent, confidence in a diagnosis increases; if key expected signs are absent, reconsider the diagnosis.

An examination that feels unnecessary, clumsy, or overly intrusive can damage the relationship you have worked to build.

Take-home message

For many patients, information exchange goes beyond spoken communication: asking questions, listening, and sharing. It also includes examining the patient.

Perform an examination only when indicated, with clear aims and the patient’s informed consent. Tailor it to the individual, interpret findings in the full clinical context, and never let technique overshadow respect.

For some, the examination is the most important part of the consultation; for others, it is a safety net. Whatever the reason, the signs you find, or fail to find, should always be interpreted alongside everything else you know about the patient.

In the next post, I will discuss the skills required to examine the patient in real-world clinical practice.

I would value your thoughts:

What approaches have worked particularly well – or less well – in your own practice?

We explore these ideas further in The Expert Clinician: Bridging the Clinical Divide. If you’re interested in developing a more adaptive, patient-centred approach, you can read more here: