Meeting a New Psychiatrist: The Physical Exam

There’s a lot of out of date imagery of psychiatry circulating the popular media. One of those images is of a psychiatrist with a couch, having an appointment with a patient talking only to the ceiling or the wall.

Is there a space for guided introspection in modern psychiatry? Sure.

But at the end of the day, psychiatrists are physicians, and we are responsible for monitoring at least part of your physical health.

Unlike many specialities, we don’t do a similar physical exam for everyone who walks through the door. There is rarely a paper covered exam table. The exam maneuvers you need may change depending on where you are in your treatment course. However, depending on your diagnoses or concerns, a psychiatrist will perform physical exam maneuvers.

Frequently, we complete variations on a neurological exam. For example:

How is your gait?

Do you have any tremors?

Are there any signs of muscular weakness?

How is your coordination?

What is your pupillary response?

If you are taking certain medications, we will also collect data on your height and weight, and temperature, as well as how your blood pressure changes depending on whether you are lying down, sitting, or standing.

With children, I try to make all of these exam maneuvers a game, where they copy what I’m doing. With adults, I can work exam maneuvers into the rest of their appointment and our conversations. I find that it lowers anxiety about “the numbers being correct”.

Not every patient needs a physical exam during their intake appointments. But when your psychiatrist is getting to know you, they will likely perform a few exam maneuvers just to learn your baselines and go from there.