There are two major principles underlying an efficient physical examination. First, the examination is done by regions, second, there is a well-organized order of examination. To be efficient, one approaches regions sequentially, for example, the head, the neck, the posterior thorax and lungs, and the heart. This type of regional approach also takes into account the comfort of the patient by eliminating the need for frequent shifts in position. One begins with a general survey of each region and then focuses on component parts. If no abnormality is found, the examination is brief but comprehensive. If an abnormality is present, it is studied meticulously, using special maneuvers if necessary. One takes advantage of the symmetry of the human body by comparing one side with the other. In this way, subtle changes are recognized. Small differences in the lung examination, for example, are better detected by cross-comparing symmetrical areas of each lung than by examining each lung individually.

　　Following a prescribed order of examination by regions does not imply a lack of flexibility. The examination varies with the condition of patient and the type of problem present. Evidence of disease in one area alerts the physician to possible related abnormalities in other areas. If the initial physical examination has not been entirely satisfactory, one does not hesitate to return at a later time to recheck findings when circumstances for re-examination may be more favorable.

　　The physician learns to do a comprehensive screening examination. Depending on the condition of the patient, the examination will need to be adapted to special circumstances. The patient may be bed-bound and so ill that the examiner requires assistance with positioning. In an acute emergency where an abbreviated physical examination is carried out with deliberate speed, one simultaneously does a brief interview, obtains laboratory work, and initiates treatment. If the patient has a neurologic problem, a complete neurologic examination is done. Regardless of the problem and the condition of the patient, the physician is considerate, systematic, and logical in approach. One keeps in mind diagnostic possibilities, looks for unsuspected disease, and interrelates abnormal findings that may explain the patient’s illness.

　　New Word and Expressions

　　Underlie 位于……之下

　　sequentially 连续地、相继地

　　posterior 后面的、以后的

　　thorax 胸、胸膛

　　anterior 前面的、先前的

　　comprehensive 全面的、综合的

　　meticulously 细致地、一丝不苟地

　　symmetry 对称，匀称

　　imply 暗示，意指

　　bed-bound 卧床的

　　neruologic 神经病的

　　diagnostic 诊断的

　　unsuspected 不受怀疑的，未知的

　　interrelate 相互联系