What you should know about physical evaluations in psychiatric patients. Results of a survey

Physical illness often initially manifests as a disturbance in thought, behavior, or mood; thus an important aspect of the psychiatric evaluation is differentiating organic disease from "functional" psychiatric disorders. A group of clinically oriented psychiatrists were surveyed about their attitudes and practices regarding medical evaluation in psychiatric patients. Thirty-seven percent of those surveyed performed physical examinations in 60%-100% of their inpatients whereas only 5% performed such examinations on outpatients. Of the 123 respondents, 63 did not perform physical examinations on any of their patients. Twenty-four percent of those who did not perform physicals also did not utilize internists or family practitioners to exclude the possibility of organic disease as a complicating factor in the psychiatric presentation. Those who considered themselves "biologically oriented" were twice as likely to include a physical examination in their inpatient evaluation as those who described themselves as "eclectic" psychiatrists; however, 30% still did no physical examinations in their practice. These findings suggest that though the ability to identify organic illness as a cause for psychiatric symptoms is considered important, psychiatrists often do not utilize the physical examination as a technique in uncovering physical disease.