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 my previous post, “Making the Physical Examination Count: What Actually Works in Real Consultations,” I explored how to adapt textbook examination skills to real-world practice.
Examining a patient is challenging enough when they understand and cooperate, but not every patient fits this scenario. Some patients, including children, may be shy or reluctant. Others have physical disabilities that make positioning or transfers difficult, while some face communication or sensory barriers.
This blog provides a guide to examining children, older adults, and people with disabilities. These principles apply to all populations discussed below. The aim is to ensure everyone has equal access to thorough, respectful care through clear communication and sensible adaptations, rather than by omitting essential parts of the examination.
General Principles
Providers must make reasonable adjustments: accessible equipment, additional scheduled time, and assistance with transfers. Omitting parts of the examination or requiring patients to bring their own helper is unacceptable.
Know the patient.
Review their records in advance to identify communication needs, sensory issues, mobility requirements, and relevant medical history. Do not assume that a physical disability equates to cognitive impairment.
Before starting the examination, talk with the patient about their daily life. This gives a more accurate picture of their abilities and limitations than relying on assumptions. Some patients are open and detailed, while others are stoic and minimise their symptoms. Treat each person as an individual.
Show Respect
The patient decides whether a companion remains present during the examination. Show respect by asking permission, finding out what works best, and explaining what you plan to do. Address the patient directly, not the companion, interpreter, or caregiver, unless the patient prefers otherwise or lacks capacity.
Treat mobility aids, such as wheelchairs, walkers, and canes, as extensions of personal space. Never touch or move them without permission.
Communicate
Patients are often experts in their own bodies. Ask about their preferred communication methods, assistance needs, transfers, positioning, pain triggers, sensory sensitivities, and the safest way to perform specific manoeuvres.
Explain what you will do and why. Allow time to process the information and to check understanding. Use plain language, short sentences, and visual aids or demonstrations where helpful. Pause regularly and offer breaks.
Examining a Child: Turn It into Play
A clinical examination can frighten a young child. Reframing it as play builds trust and encourages cooperation.
Children are not being “difficult”; they are protecting themselves. Time spent helping a child feel safe builds lasting trust. Have a plan, show respect, and make the examination fun.
Set the scene by demonstrating first. You might demonstrate the action on a soft toy, the parent’s arm, or your own hand before approaching the child.
Build trust by asking permission repeatedly. “Is it okay if I listen to your heartbeat now?”or “Can I check your tummy?”
Explain with imagination. “I’m going to listen to your heart with a special listening tube for superhero hearts,” or “This is my magic telescope; it helps me spot sneaky ear monkeys!”
Praise effort and specific actions. “Thank you for keeping your arm so still; that was really helpful.” Specific praise is more effective than general compliments.
Finish on a high note. The way the consultation ends often shapes how the child and parent feel about returning. Acknowledge the child’s bravery: “You were really brave today, even when you felt scared.” Offer a small reward, such as a sticker, badge, or stamp. Say goodbye directly to the child to reinforce that they were the most important person in the room.
Examining an Older Adult: The Collaborative Examination
Ageing brings diversity. While many older adults remain highly independent, others may experience sensory changes, reduced mobility, joint stiffness, or slower processing speed. Treat every encounter as a collaboration.
Show respect. Ask permission before touching or moving the patient, and explain each step in plain language. Many older adults appreciate being treated as partners rather than as passive recipients of care.
Slow the pace. Allow extra time for undressing, positioning, answering questions, and recovery between manoeuvres. Rushing increases anxiety and the risk of incomplete information.
Signal transitions clearly. Give advance warning before standing, turning, or examining a new area: “In a moment, I am going to help you sit up so I can listen to your back.”
Prioritise safety. Keep pathways clear. Offer a steadying hand or a gait belt when appropriate. Ensure the examination table is at a comfortable height and that the patient can get on and off safely. Watch for orthostatic symptoms when changing posture.
Account for common age-related changes without assuming frailty or cognitive impairment:
- Sensory: Speak clearly, face the patient, reduce background noise, and confirm that hearing and vision aids are in place and working.
- Musculoskeletal: Joint stiffness and reduced range of motion are common. Involve the patient in decisions about positioning and the order of the examination. Avoid forcing movements.
- Skin and soft tissue: Skin may be thinner and more fragile. Handle gently and inspect pressure areas carefully.
- Cognition and communication: Some patients process information more slowly. Use short sentences, allow time for replies, and check understanding. Never equate age with reduced capacity.
- Energy and comfort: Fatigue can set in quickly. Offer rest breaks and prioritise the key elements of the examination if time or stamina is limited.
- Balance and coordination: Ask about daily function, falls, pain, and what usually helps or hinders movement.
Examining a Person with a Disability: Show Respect and Understanding
Ensure the space is accessible, with clear pathways, sufficient room for a wheelchair or an assistant, an adjustable examination table (ideally lowering to approximately 17–19 inches, wheelchair-seat height), good lighting, and minimal noise or distractions.
Schedule extra time when transfers, communication, or processing may take longer than expected.
Offer assistance, then wait for instructions. Do not assume help is needed or how to provide it. Ensure appropriate support and safety during transfers or positioning.
As a principle, begin with less invasive or more comfortable areas. Monitor for fatigue or distress, and pause as necessary.
When performing the indicated examination, adapt positioning and technique rather than omitting any part.
Mobility Disabilities and Wheelchair Users
Many cardiorespiratory assessments can be performed while seated if clinically appropriate. Transfer to an accessible examination table when a thorough assessment is required.
Ask how the patient prefers to transfer and position.
While examining, watch for spasms, protect skin integrity (especially in pressure areas), and note range-of-motion limitations.
For pelvic examinations in patients with paralysis or limited mobility, discuss positioning alternatives and avoid unnecessary use of stirrups when other support is sufficient.
Intellectual, Developmental, or Communication Disabilities
Explain and demonstrate each step. Offer simple choices when possible — “Shall we check your heart first or your ears?” Use modelling or visual supports. Proceed slowly and praise cooperation.
Watch for non-verbal cues of discomfort.
Neurologic or Motor Impairments
Perform systematic testing of strength, tone, sensation, reflexes, and function, adapting for amputations, contractures, or limited voluntary effort. Compare sides where relevant and document residual function carefully.
Examining a Person Who Is Hard of Hearing or Deaf: The Coordinated Examination
Face the patient and speak clearly at a normal volume — do not shout. Minimise background noise. Provide written information or a qualified interpreter, as the patient prefers. Confirm their understanding.
Establish non-verbal signals in advance, such as a thumbs-up or a tap on the arm, so the patient can communicate pain or signal the need to stop when their face is not visible.
Explain the process before touching. Patients who are Deaf or hard of hearing cannot hear commentary when you are behind them or when you are using a stethoscope.
Maintain visual contact. If you must look away to retrieve an instrument, pause speaking until you are facing the patient again.
Examining a Person with Partial Sight or Blindness: The Step-by-Step Tactile Examination
Identify yourself and anyone else present. Describe the room layout and what you are doing. Provide verbal guidance on positioning.
Ask for permission and give advance notice. Before making contact, explain exactly what you will do and where you will touch: “I am going to place my hand on your right shoulder now to listen to your chest.”
Never touch a patient with visual impairment unexpectedly.
Maintain light physical contact or provide clear narration during transitions to prevent the patient from being startled by sudden instrument movement.
Explain clinical instruments in advance. If something will feel cold, make a noise, or produce a puff of air, say so a moment beforehand.
Documentation and Follow-Up
Document the adaptations used, patient preferences that worked well, functional findings, and any barriers encountered. This information supports continuity of care. Whenever possible, provide written or electronic information in accessible formats.
Important Caveats
This guidance is based on accessibility standards, clinical best-practice resources, and disability-informed care principles. Specific techniques vary by the type and severity of the disability or sensory impairment, the clinical indication and setting, the examination type, and local regulations and available equipment.
Always adhere to your professional training, institutional policies, and applicable laws. If uncertain, ask the patient and consult specialists as needed.
Key Takeaways
- Ask, listen, and adapt; never assume.
- Address the patient directly and treat mobility aids as personal space.
- Invest time in clear explanation, demonstration, and obtaining permission.
- Adapt technique and positioning rather than omit essential parts of the examination.
- Document what works so the next HCP is forewarned.
These approaches help ensure that every patient receives a thorough, respectful examination tailored to their needs.
Click the link for more information 👉 A Guide to Examining a Person with Disability.
In the next post, I will discuss assumptions and errors in the physical examination.
Perhaps you’d like to share some of your thoughts:
Do you have any tips for examining patients with different needs?
If you’re interested in developing a more adaptive, patient-centred approach, you can read more here:
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