The visual observation begins when the doctor and patient meet and ends when the patient closes the door after the consultation. Therefore, inspection is an activity that is not just limited to the initial part of the examination. Nevertheless, considerable benefits can be gained if part of the overall examination is explicitly dedicated to the inspection.
A number of criteria must be satisfied for maximum benefit to be obtained from this subsidiary examination:
- Ambient temperature should be comfortable.
- There must be sufficient space and uniform lighting.
- Privacy must be sufficiently safeguarded.
- Patient should be sufficiently undressed.
- Patient should be in the correct position (standing, sitting, lying).
- Examiner must be able to stand at sufficient distance from the patient (postural aspects in particular, can only be assessed properly at a sufficient distance).
- Clear and simple instructions must be given to the patient.
During the inspection, attention should be paid to the following four aspects:
- Shape – Mainly determined by bones, joints, muscle and fat tissue.
- Skin – Colour, hair cover, scars, vascular pattern and other aspects often provide important information about underlying conditions or abnormalities.
- Position – Everything related to posture, e.g. the position of the lower leg with respect to the upper leg (genu varum/genu valgum, hyperextension or hyperflexion of the knee) or position of the spinous process (scoliosis). Initially, it is wise to examine the patient in the spontaneously-adopted initial posture and only then in the ‘anatomical position’. In the spontaneously-adopted posture, certain abnormalities might already be apparent (genu valgum). In the anatomical posture, the patient should stand upright, with face and feet pointing forwards and arms along the side of the body and the palms of the hands facing forwards.
- Movement – Spontaneous movements (pulsations, fasciculations, tics, breathing movements). Voluntary movements are assessed during walking and the active movement tests. Left and right differences determine the degree of symmetry and are expressed in the shape and/or posture and movement (e.g. muscle atrophy). Sometimes structures observed during the inspection need to be confirmed by palpation.