The Physical Exam: Are you getting what you pay for?

Today, the average veterinary physical exam is $50-$55. That’s a lot of dough!  So, how can you be sure you are getting what you pay for and your pet is receiving the medical care he/she deserves? We have outlined what a complete physical exam should consist of so that you can be sure your vet is practicing quality medicine and not ripping you off!

Prior to the physical exam, the technician should perform all of the following to present to the veterinarian prior to the examination.

  • Signalment – Technician or Receptionist should collect a complete description of the animal including: species, breed, age, sex, reproductive Status, and other distinguishing characteristics. Did you know, certain breeds are at higher risks for some diseases that others? It’s important to research your pet’s breed so that you can discuss these diseases with your medical care team.
  • Complete Medical History – A full medical history should be recorded including environment, diet, medical history, reproductive history, vaccination status, current medications, description and history of chief/presenting complaint.
  • Vital Signs –  These consist of weight, temperature, heart rate, respiratory rate, mentation, gum color, and capillary refill time. Sadly, these vital signs are often overlooked.

Once the veterinarian has had the opportunity to review the technician’s findings and study the medical history, they will begin the hands on physical exam. Generally, the best approach to a physical exam is to start from the tip of the nose and work backwards toward the tail to ensure all body systems are evaluated.

  • General Appearance – The vet should take a step back and observe the pet’s overall appearance, paying attention to symmetry, posture and gait, mentation (level of consciousness and attentiveness), and hydration status. In older patients or in patients with limb related concerns (like limping) the veterinarian should watch the pet walk from various vantage points to evaluate gait.
  • Head/Neck:
    • The nose should be examined for symmetry, conformation, and evidence of discharge.
    • Eyes should be evaluated for size, position, and discharge. This should include evaluation of the lids, conjunctiva, sclera, pupil, cornea, and lens. The veterinarian should be using an opthalmoscope – proper evaluation can not be performed with the naked eye.
    • The oral cavity – lips, mucous membranes, all teeth, hard and soft palate, tongue, pharynx, tonsils should all be evaluated. A quick lift of the lip is not adequate.
    • The ears – general overview of the outer ear should be performed followed by an in-depth evaluation of the middle and inner ear using an otoscope. Proper exam of the ear can not be performed with just the naked eye.
    • Palpation of the submandibular lymph nodes, salivary glands, larynx and thyroid gland (not always palpable)
    • Palpation of the trachea.
  •  Thorax
    • General observation should be performed checking for conformation and symmetry.
    • Palpation of the thoracic region should be performed to check for masses and to elicit any possible pain.
    • Cardiac auscultation – the veterinarian should listen carefully to the heart to evaluate heart rate, rhythm, and heart sounds. Silence and concentration is important in order to listen for heart murmurs, muffled sounds, and arrhythmias.
    • Respiratory auscultation – the veterinarian should listen carefully for noisy breathing at the mouth and nose without a stethoscope. Then the lungs should be evaluated using the stethoscope by listening to at least 4 different areas of the chest. Silence is important in order to listen for abnormal sounds including wheezes, rales/crackles, musical sounds (rhonchi), dull lung sounds, and absence of breath sounds.
  •  Abdomen
    • General observation should be performed to inspect for distention, deformity, displacement, symmetry, and bruising.
    • The abdomen should be auscultated to detect intestinal motility.
    • Abdominal Palpation is very important. This allows the veterinarian to evaluate organ size and location, presence of fluids or gases, presence of masses/growth, and any possible pain or guarding.
  • Trunk and limbs
    • Inspect all limbs and trunk for symmetry, masses, tenderness, etc.
    • Palpation of spine for possible deviations and pain.
    • Palpation and manipulation of each limb and joint individually – noting abnormalities in angulation, deformities, swelling, bleeding, bony protrusions, obvious fractures or joint laxations, range of motion, atrophy, knuckling, and crepitus.
    • All limbs/joints should be assessed in weight-bearing and non-weight bearing positions.
    • All feet, nails, or hooves should be closely inspected, palpated, and manipulated.
    • Muscles mass and tone should be evaluated.
    • Skin and haircoat should be examined for alopecia, masses, parasites, dryness, excessive oil, matting, etc.
    • Palpation of the pelvic region for conformation, symmetry, and possible pain.
    • Palpation of peripheral lymph nodes  (prescapular, axillary, inguinal and popliteal)- this is important as lymph nodes can indicate local or systemic infection, allergies, or neoplastic disease.
  • External genitalia and perineum – The sex and reproductive status of the patient should always be confirmed. The perianal area should be inspected for matts, hernias, feces, masses, discharge, or evidence of parasites.
    •  In males – the prepuce and penis should be evaluated to check for discharge, inflammation, and tumors. If intact, both testicles should be evaluated for symmetry, size, location, and conformation. A rectal exam should be performed to evaluate prostate.
    • In females – The mammary glands should be palpated and visually evaluated to check for tumors, cysts, swelling, heat or discharge. The vulva should be evaluated for size, inflammation, discharge, polyps, tumors, or structural defects.

Once the veterinarian has finished the exam, he/she should review his/her findings with you. Together, you and the veterinarian should discuss the findings and construct a treatment plan that is best for your pet and for your budget.

Too often veterinarians do not perform a complete physical exam. Often it is because the patient is presented for a specific complaint (ex: limping) and the rest of the exam is overlooked as the vet focuses on the primary complaint – but keep in mind you are paying for a complete exam and the entire overall condition of the pet should still be evaluated. Other times, vets may shorten the exam to save time – maybe they are overbooked or have fallen behind – the physical exam is an easy place to save some time. Regardless of the reasoning, failure to perform a complete physical exam is poor business and very poor medicine.

Don’t underestimate the importance of the physical exam!

 

 

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