Do psychiatrists examine patients? A quantitative approach to audit physical examination in psychiatric wards

Abstract

Our aim was to assess our practice of physical examination retrospectively from clinical notes against set local standards. The objectives were to find out the number of examinations attempted on admission, and to ascertain the thoroughness of the examinations by quantifying the assessment of each system (cardiovascular, central nervous system, etc). We reviewed clinical notes of 29 patients in acute psychiatric wards. Physical examination was attempted on 23 out of 29 patients at the time of admission, giving us an attempt rate of 79%. The overall thoroughness of our sample, as derived by calculating the mean of the average scores for all systems, was 29%. The most comprehensively done system in our sample was the cardiovascular with a score of 55%. The locomotor system was the worst with a score of only 15%. We think the method of ascertaining the thoroughness of physical examination, as used in this audit, can be used in other psychiatric wards and probably in other disciplines as well. We believe the method provides some objectivity to the assessment of thoroughness in physical examination audits.