A national survey of psychiatrists' attitudes towards the physical examination

Background: Studies have shown that most psychiatric patients do not receive a thorough physical examination (PE).Aim: To explore factors contributing to the underperformance of the PE on psychiatric patients.Method: All psychiatrists in the UK who were registered or affiliated to the Royal College of Psychiatrists were invited to complete an online survey regarding their attitudes towards PEs in psychiatry.Results: Responses from 15% of the psychiatrists showed that most (89%) believe that the PE is important. The majority (61%) indicated that their PE skills had diminished since working in psychiatry and this was reported more by senior psychiatrists than junior trainees (64% vs. 49%). Most respondents considered that the PE should not be done by another type of health professional (45% vs. 28%).Conclusions: Likely reasons for poor performance of PEs include shortage of time and equipment, challenges associated with agitated and uncooperative patients, the perceived incongruence of the PE with the patient's presenting symptoms and a degree of skill atrophy, especially in senior psychiatrists which is leading to lack of supervision of junior trainees in this area. Further research is needed to investigate if strategies addressing these factors would improve the standard of PEs on psychiatric patients.