Health Assessment and Physical Examination
Core concepts
Health assessment combines the health history (chief complaint, history of present illness, past medical history, medications, allergies, family and social history, review of systems) with the physical examination using inspection, palpation, percussion, and auscultation - in that order, except for the abdomen, where auscultation precedes palpation and percussion to avoid altering bowel sounds. Know normal findings and their common deviations: vesicular versus bronchial breath sounds, crackles versus wheezes, S1/S2 and extra heart sounds, bowel sound frequency, and normal ranges for vital signs across age groups. Mental status, skin, and functional assessment are integral, not optional. Cultural and developmental variation shapes what counts as normal.
Traps
Frequent errors include palpating the abdomen before auscultating, interpreting a single abnormal vital sign as diagnostic without context, and confusing subjective (what the patient reports) with objective (what you observe or measure). Pain is subjective even when scored numerically. Another trap is attributing an older adult's confusion to "normal aging" - acute change is delirium until proven otherwise. Also, do not document findings you did not personally elicit.
Rule of thumb
Inspect before you touch, and auscultate the abdomen before you palpate. When a finding surprises you, repeat it, compare sides, and correlate with history before acting.
Worked example
A patient reports new shortness of breath. Inspection shows accessory muscle use; auscultation reveals bilateral crackles; vital signs show SpO₂ 89% on room air. The finding is objective and supports a respiratory problem. The correct next step is to position upright, apply oxygen per protocol, and escalate - not to document and wait for rounds.