Evidence-based Synthesis Program Department of Veterans Affairs

Health Services Research & Development Service

October 2011

Prepared for:

Department of Veterans Affairs

Veterans Health Administration

Health Services Research & Development Service

Washington, DC 20420

Prepared by:

Evidence-based Synthesis Program (ESP) Center

Minneapolis VA Medical Center

Minneapolis, MN

Timothy J. Wilt, M.D., M.P.H., Director

Evidence Brief:

Role of the Annual Comprehensive 

Physical Examination 

in the Asymptomatic Adult

Investigators:

Principal Investigators: 

Hanna E. Bloomfield, M.D., M.P.H.

Timothy J. Wilt, M.D., M.P.H.

Contributing Investigators: 

Kristine Ensrud, M.D., M.P.H.

Craig Roth, M.D.

Frank Lederle, M.D.
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Evidence Brief: Role of the Annual Comprehensive Physical 

Examination in the Asymptomatic Adult Evidence-based Synthesis Program

PREFACE

Health Services Research & Development Service’s (HSR&D’s) Evidence-based Synthesis 

Program (ESP) was established to provide timely and accurate syntheses of targeted healthcare 

topics of particular importance to Veterans Affairs (VA) managers and policymakers, as they 

work to improve the health and healthcare of Veterans. The ESP disseminates these reports 

throughout VA.

HSR&D provides funding for four ESP Centers and each Center has an active VA affiliation. The 

ESP Centers generate evidence syntheses on important clinical practice topics, and these reports 

help:

• develop clinical policies informed by evidence,

• guide the implementation of effective services to improve patient outcomes and to 

support VA clinical practice guidelines and performance measures, and 

• set the direction for future research to address gaps in clinical knowledge.

In 2009, the ESP Coordinating Center was created to expand the capacity of HSR&D Central 

Office and the four ESP sites by developing and maintaining program processes. In addition, 

the Center established a Steering Committee comprised of HSR&D field-based investigators, 

VA Patient Care Services, Office of Quality and Performance, and Veterans Integrated Service 

Networks (VISN) Clinical Management Officers. The Steering Committee provides program 

oversight, guides strategic planning, coordinates dissemination activities, and develops 

collaborations with VA leadership to identify new ESP topics of importance to Veterans and the 

VA healthcare system.

Comments on this evidence brief are welcome and can be sent to Nicole Floyd, ESP 

Coordinating Center Program Manager, at nicole.floyd@va.gov.

Recommended citation: Bloomfield HE, Wilt TJ. Evidence Brief: Role of the Annual 

Comprehensive Physical Examination in the Asymptomatic Adult, VA-ESP Project #09-009; 

2011.

This report is based on research conducted by the Evidence-based Synthesis Program 

(ESP) Center located at the Minneapolis VA Medical Center, Minneapolis, MN funded 

by the Department of Veterans Affairs, Veterans Health Administration, Office of 

Research and Development, Health Services Research and Development. The findings 

and conclusions in this document are those of the author(s) who are responsible for 

its contents; the findings and conclusions do not necessarily represent the views of 

the Department of Veterans Affairs or the United States government. Therefore, no 

statement in this article should be construed as an official position of the Department 

of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., 

employment, consultancies, honoraria, stock ownership or options, expert testimony, 

grants or patents received or pending, or royalties) that conflict with material presented 

in the report.
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Evidence Brief: Role of the Annual Comprehensive Physical 

Examination in the Asymptomatic Adult Evidence-based Synthesis Program

INTRODUCTION

The routine annual comprehensive physical examination (PE) became a fixture in American 

medical practice in the 1940’s. By the 1980’s many influential professional groups, including 

the American Medical Association, the American College of Physicians, the United States 

Preventive Services Task Force (USPSTF) and the Canadian Task Force on Periodic Health, 

recommended that this approach be replaced by periodic screening, counseling and PE tailored 

to a patient’s age, sex, risk factors, and symptoms as elicited by the medical history and review 

of systems (Oboler 2002). Furthermore, these recommendations tacitly or explicitly endorse 

the concept that, for screening purposes, only those components of the PE that accurately and 

effectively detect conditions for which early diagnosis is known to lead to improved patient 

outcomes should be routinely offered.

Consistent with this tailored and evidence-based approach, Medicare currently offers a 

free initial “Welcome to Medicare” visit which includes a medical history, recommended 

immunizations and screenings and “further tests depending on your health and medical history”. 

The only components of the PE recommended for everyone are measurement of blood pressure, 

vision, weight and height (www.medicare.gov/welcometomedicare/visit.html).

Nevertheless, most adults in the US believe that annual comprehensive physical exams are 

important; a 2002 study showed that more than 90% endorse the value of routine examination 

of the heart, lungs, abdomen, reflexes and prostate (Oboler 2002). Moreover, as recently as 

2005, many physicians also endorse the complete annual physical examination for a variety of 

reasons including perceived benefits to the physician-patient relationship, patient expectations 

for a yearly “physical,” fear of malpractice litigation, and compensation (Frame 1995, 

Prochazka 2005). The purpose of this review is to determine whether the routine annual physical 

examination results in improved outcomes for asymptomatic adults. 

OBJECTIVES

PRIMARY: To evaluate the value of the routine (e.g. annual) physical examination in 

asymptomatic average risk adults. Specifically, what components of the routine physical 

examination are currently recommended by high-quality evidence-based guidelines or reports.

SECONDARY: To determine if designating a specific visit for the provision of evidence-based 

preventive services (often referred to as a periodic health examination) increases the likelihood 

that patients will receive these services. 

WE ONLY REVIEW COMPONENTS OF THE ACTUAL PHYSICAL EXAMINATION; 

WE DO NOT INCLUDE: 

1. Screening and preventive interventions that consist of history taking and/or counseling 

(e.g. risk assessment and counseling for issues such as tobacco use, injury prevention, sun 

exposure, overweight) or that are not physical examination procedures (e.g. immunizations, 

colon cancer screening with colonoscopy, breast cancer screening with mammography, 

osteoporosis screening with DEXA scans, blood tests for cholesterol) 
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Evidence Brief: Role of the Annual Comprehensive Physical 

Examination in the Asymptomatic Adult Evidence-based Synthesis Program

2. Physical examinations performed to further elucidate patient symptoms, risk factors or 

concerns 

3. Physical examinations performed to meet insurance, disability, employment or participation in 

sports requirements 

METHODS

For the primary objective, we included the common components of the routine physical 

examination (see tables 1 and 2). For each component we reviewed the most recent 

recommendations of the USPSTF. “For the USPSTF to recommend a service, the benefits of the 

service must outweigh the harms. The USPSTF focuses on maintenance of health and quality 

of life as the major benefits of clinical preventive services, and not simply the identification of 

disease” (w w w .uspreventiveservicestaskforce.org/index.html accessed August 31, 2011). 

For components of the PE not included in the USPSTF recommendations, we first reviewed a 

comprehensive systematic review on this topic (Oboler and LaForce, 1989). This review was 

based on an extensive computerized search of the medical literature from 1966 through 1988, 

using key words body temperature, respiratory rate, heart rate, auscultation [abdomen, carotid 

artery, heart], palpation [abdomen, peripheral pulse, lymph node, spleen, liver], digital rectal 

examination, pulse, hearing tests, breast examination, lung percussion, muscle stretch reflex; 

and terms for routine physical examination. Oboler and LaForce graded evidence as Grade I 

(evidence from at least one properly randomized controlled trial); Grade II (evidence from welldesigned cohort or case-control studies; non-randomized controlled trials; or from “comparisons 

between times or places with or without the intervention” p. 215); Grade III (opinions of 

respected authorities or expert committees, evidence from other studies, or clinical experience). 

To identify literature published since the Oboler and LaForce review, we conducted a 

computerized literature search of MEDLINE (1988 through August 2011) using the key words 

listed above. We limited the results to English language, human studies, adult patients, and 

meta-analysis or systematic reviews. Studies were considered eligible if they assessed clinical 

outcomes related to specific physical examination procedures in asymptomatic adults. We 

excluded articles that only described diagnostic accuracy. We also reviewed the 53 chapters 

of The Rational Clinical Examination, a compilation of articles from JAMA focusing on 

evidence-based clinical diagnosis (Simel 2009); and current VA/DoD Clinical Guidelines

(www.healthquality.va.gov). 

For the secondary objective, we identified a systematic review which had surveyed the literature 

through 2004 (Boulware 2007). To update this, we performed a MEDLINE search from 2004 

through August 2011 using the same key words (e.g. physical examination, yearly, annual, 

periodic, multiphasic screening, preventive health services) limited to English language, human 

studies, adult patients and to meta-analyses or systematic reviews. 
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Evidence Brief: Role of the Annual Comprehensive Physical 

Examination in the Asymptomatic Adult Evidence-based Synthesis Program

RESULTS

PRIMARY OBJECTIVE: To evaluate the value of the routine (e.g. annual) physical 

examination in asymptomatic adults. Specifically, what components of the routine physical 

examination are currently recommended by high-quality evidence-based guidelines. 

As shown in the figure our search produced 389 abstracts of which 10 met preliminary 

eligibility criteria and were retrieved for full article review. Three of these contained relevant 

information and were included along with 8 additional articles identified by a hand search of the 

bibliographies of key articles. 

USPSTF Recommendations (table 1): Of the components of the physical examination 

evaluated by the USPSTF, 3 are currently recommended (blood pressure every 2 years, 

weight, and PAP smear for sexually active women with a cervix every 3 years up to age 65); 

5 are recommended against (pelvic examination for ovarian cancer; PAP smear for women 

age > 65 who have had adequate screening in the past, women without a cervix or age < 21; 

testicular examination for testicular cancer; abdominal examination for pancreatic cancer; 

and thyroid examination for thyroid cancer); and for 4 there is insufficient evidence to make 

a recommendation either for or against (mouth examination for oral cancer, screening for 

hearing loss in adults over age 50, whole body skin examination for skin cancer, clinical breast 

examination for cancer, and eye exam for either visual loss or glaucoma). 

An additional 4 components (carotid artery auscultation for carotid artery stenosis, peripheral 

pulse palpation for peripheral vascular disease, lung auscultation for chronic obstructive 

pulmonary disease and abdominal palpation for abdominal aortic aneurysm) were not explicitly 

evaluated by the USPSTF. However, in its reviews of laboratory screening tests for these 

conditions, these PE components were designated not useful (table 1). 

Other Recommendations (table 2): For components of the PE not addressed by the USPSTF, 

we looked for recommendations in other sources (see methods). Several elements of the PE (e.g. 

musculoskeletal examination and examination of the legs for edema) were not covered in any of 

these sources.

Recommended. Oboler and LaForce (1989, p. 219) recommended heart auscultation once at the 

first adult exam and then again at age 60 for detection of valvular disease. However, the JAMA 

Rational Clinical Examination states that there are no data on indications for auscultation for 

systolic murmurs (Simel 2009 p. 443). Measurement of pulse to screen for atrial fibrillation in 

adults over age 65 is recommended by at least one source (Fitzmaurice 2007). 

Not Recommended. Lymph node palpation, heart auscultation for detection of coronary artery 

disease or atrial fibrillation, palpation of liver and spleen for hepato-splenomegaly, assessment of 

spine mobility for risk of back pain, testing of peripheral reflexes and sensation for neuropathies, 

and abdominal auscultation for renovascular hypertension were not recommended by Oboler and 

LaForce (Oboler 1989).

Insufficient Evidence. Digital rectal exam for prostate or rectal cancer; and measurement of 

temperature and respiratory rate were deemed by Oboler and LaForce to have insufficient 

evidence on which to base a recommendation. 
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Evidence Brief: Role of the Annual Comprehensive Physical 

Examination in the Asymptomatic Adult Evidence-based Synthesis Program

Comments on Selected Physical Examination Components:

Screening for Hearing Loss. The USPSTF has determined that there is insufficient evidence 

for this procedure for adults above 50 (see table 1). However, a randomized trial in veterans 

over age 50 assessed the efficacy of immediate hearing aids versus wait list in individuals 

with hearing loss detected either by screening (hand held audiometric device) or because of 

patient-reported hearing problems. Compared to the wait list group, the immediate hearing aid 

group had sustained improvements in hearing related communication measures and small but 

statistically significant improvements in depression and cognitive scores. Results were similar in 

the screen detected and the symptomatic group (Yueh 2010). 

Digital Rectal Examination (DRE). The evidence for performing a DRE for screening for either 

rectal or prostate cancer was deemed to be insufficient by Oboler and LaForce (table 2). No 

studies have assessed the benefits and harms of the DRE for colorectal cancer (CRC) screening

and no major organization (VA, USPSTF, American College of Physicians, American Cancer 

Society) recommends it. The 2008 USPSTF recommendations evaluated several procedures for 

CRC screening. The DRE was not considered as an option.

Currently, the majority of prostate cancers are found by screening with the prostate specific 

antigen (PSA) test, which has been given an “insufficient evidence” rating by the USPSTF for 

men younger than 75 years of age and a recommendation against screening for men age 75 years 

and older. No screening or treatment trials have adequately assessed the benefits and harms 

of the DRE for prostate cancer screening in the absence of other procedures (i.e. PSA testing). 

Moreover, no screening trials, most of which relied primarily on PSA testing, have shown a 

reduction in prostate cancer or overall mortality. One randomized screening trial in the US 

specifically included annual DRE with PSA testing. Among men assigned to 6 annual rounds of 

PSA screening that included 4 rounds of DRE there was no reduction in prostate cancer mortality 

through 10 years of follow-up compared to men assigned to usual care (Andriole 2009). 

Clinical Breast Examination (CBE). The current evidence is insufficient to assess the additional 

benefits and harms of CBE beyond screening mammography in average risk women age 40 and 

older (table 1). However according to the USPSTF indirect evidence “suggests that CBE may 

detect a substantial proportion of breast cancers if it is the only screening test available” and should 

be considered by the clinician in high risk patients (e.g. genetic mutations BRAC1, BRAC2, history 

of chest radiation) or if mammography is either not available or refused by the woman (w w w 

.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanrs.htm accessed Aug 31, 2011).

Auscultation of Carotid Arteries. The USPSTF recommended against screening for 

asymptomatic carotid artery stenosis (table 1). This recommendation focused on screening to 

determine need for carotid endarterectomy. However, some clinicians may auscultate the carotid 

arteries for bruits to further assess cardiac risk in patients who are not high risk by conventional 

criteria (e.g. Framingham Risk Score) to determine whether to initiate preventive interventions 

such as aspirin or statins. It should be noted, however, that the USPSTF concluded in 1996 that 

cartotid artery auscultation had poor reliability and sensitivity for detection of bruits. 

Abdominal Palpation. The USPSTF recommends one time screening for abdominal aortic 

aneurysm (AAA) with ultrasonography in men aged 65 to 75 who have ever smoked (table 1). 
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Evidence Brief: Role of the Annual Comprehensive Physical 

Examination in the Asymptomatic Adult Evidence-based Synthesis Program

They comment that abdominal palpation has poor accuracy and is not an adequate screening test 

for AAA. As noted above the USPSTF recommends against abdominal palpation for pancreatic 

cancer screening. Oboler and LaForce do not recommend palpation of the liver and spleen for 

hepato-splenomegaly (1989). 

SECONDARY OBJECTIVE: To determine if designating a specific visit for the provision of 

evidence-based preventive services (often referred to as a periodic health examination) increases 

the likelihood that patients will receive these services. 

A 2007 systematic review that included 33 studies published between 1973 and 2004 

investigated the benefits of the periodic health evaluation (PHE) (Boulware 2007). As shown in 

the figure, our updated search yielded 912 abstracts which we reviewed; 4 were retrieved for full 

article review (Robertson 2008, Milone 2006, Dubey & Glazier 2006, Dubey & Mathew 2006). 

However, since none of these 4 addressed our specific question, the summary below is based 

exclusively on the Boulware paper, a high quality review performed under the auspices of the 

Evidence Based Practice Center Program of the Agency for Healthcare Research and Quality. 

Boulware et al. defined the PHE as “one or more visits with a health care provider for the 

primary purpose of assessing patients’ overall health and risk factors for disease that may be 

prevented by early intervention...[The] definition specified the PHE as consisting only of the 

history, risk assessment and a tailored physical examination” (p. 291). This was compared to 

“opportunistic” provision of recommended services, i.e. during visits for management of chronic 

disease or acute illness. Recommended preventive services included components of the physical 

examination as well as screening tests, counseling, and immunizations. 

Of the 33 studies included in this review, 21 were identified by the authors as constituting “the 

best available evidence”. Seventeen outcomes were assessed in these studies. Results suggested 

that the PHE “had a consistently beneficial association with patient receipt of gynecological 

examinations and PAP smears, cholesterol screening, and fecal occult blood testing” (Boulware 

2007, p.289). One trial found that the PHE was associated with less patient worry. There 

were no consistent associations between the PHE and any of the other 13 outcomes evaluated 

(counseling, immunizations, mammography, disease detection, health habits, health status, blood 

pressure, body mass index, cholesterol levels, costs, disability, hospitalization and mortality). 

Although the authors concluded that the review provided “health care providers and payers 

justification for the continued implementation of the PHE” (Boulware 2007, p. 297), we are not 

convinced that this conclusion is fully supported by the data. Specifically we are concerned 

about the potential for reporting bias and chance positive findings and, most importantly, that 

benefit was found for only 4 of the 17 selected outcomes. Furthermore, given that this review 

was based on data obtained before the era of the electronic medical record (EMR), it is likely 

that the reminder capabilities of the EMR may obviate the need for designating a specific visit to 

ensure delivery of recommended preventive services. 

Other Considerations and Limitations: We did not specifically review specialty society 

recommendations although if published in the medical literature they should have been detected 

by our search. Second, we linked each component of the PE to a specific purpose (e.g. whole 

body skin examination to detect skin cancer). There might be other reasons to perform a specific 

examination, although these would generally be for symptom evaluation, which is outside the 
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Evidence Brief: Role of the Annual Comprehensive Physical 

Examination in the Asymptomatic Adult Evidence-based Synthesis Program

scope of this review. Finally, several authors point to the intangible benefits of the physical 

examination, or “laying on of hands”, such as strengthening the patient-physician relationship 

and conveying a sense of caring (Oboler 1989, Prochzka 2005, Frame 1995, Verghese 2009). 

However, we are unaware of any empirical studies evaluating these hypothesized benefits. 

CONCLUSIONS

• Comprehensive routine physical examinations are not recommended for the asymptomatic 

adult, although many patients and physicians continue to endorse the practice. 

• Components of the physical examination recommended for the asymptomatic adult include: 

o blood pressure screening every 1-2 years 

o periodic measurement of body mass index 

o PAP smears beginning at age 21 for sexually active women with a cervix every 3 years 

up to the age of 65. 

• There is some evidence that designating a specific visit for the provision of preventive 

services may increase the likelihood that patients will receive PAP smears, cholesterol 

screening and fecal occult blood testing. 
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Evidence Brief: Role of the Annual Comprehensive Physical 

Examination in the Asymptomatic Adult Evidence-based Synthesis Program

REFERENCES 

1. Andriole GL, Crawford ED Grubb RL III, et al (2009). Mortality Results from a Randomized 

Prostate-Cancer Screening Trial. N Engl J Med 360:1310-9.

2. Boulware LE, Marinopoulos S, Phillips KA et al (2007). Systematic review: The value of the 

periodic health evaluation. Ann Intern Med 146:289-300. 

3. Chou R, Dana T, Bougatsos C, et al (2011). Screening adults aged 50 years or older for 

hearing loss: A review of the evidence for the US Preventive Services Task Force. Ann Intern 

Med 154:347-355. 

4. Dubey V, Glazier R (2006). Preventive care checklist form. Can Fam Physician 52:48-55. 

5. Dubey V, Matthew R, Iglar K, Moineddin R, Glazier R (2006). BMC Family Practice 7:44.

6. Fitzmauruce DA, Hobbs FDR, Jowett S, et al (2007). Screening vsersus routine practice in 

detection of atrial fibrillation in patients aged 65 or over: cluster randomized controlled trial. 

BMJ 335:383-388.

7. Frame PS (1995). The complete annual physical examination refuses to die. J Fam Pract

40(6):543-45. 

8. Milone SD, Milone SL (2006). Evidence-based periodic health examination of adults. Can 

Fam Phys 52:40-47.

9. Oboler SK, LaForce FM (1989). The periodic physical examination in asymptomatic adults. 

Ann Intern Med 110:214-226. 

10. Oboler SK, Prochazka AV, Gonzales R, et al (2002). Public expectations and attitudes for 

annual physical examinations and testing. Ann Intern Med 136:652-59. 

11. Prochazaka AV, Lundahl K, Pearson W, et al (2005). Support of evidence-based guidelines 

for the annual physical examination. Arch Intern Med 165:1347-52. 

12. Robertson LM, Douglas F, Ludbrook A, Reid G, van Teijlingen E (2008). What works with 

men? A systematic review of health promotion interventions targeting men. BMC Health 

Services Research 8:141. 

13. Simel DL, Rennie D (eds) (2009). The Rational Clinical Examination; Evidence-based 

clinical diagnosis. McGraw-Hill, NY.

14. Vergehese A, Horwitz RI (2009). In praise of the physical examination. BMJ 339:1385-86.

15. Yueh B, Collins MP, Souza PE, et al (2010). Long-term effectiveness of screening for hearing 

loss: the screening for auditory impairment—which hearing assessment test (SAI-WHAT) 

randomized trial. J Am Geriatr Soc 58:427-34. 
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Evidence Brief: Role of the Annual Comprehensive Physical 

Examination in the Asymptomatic Adult Evidence-based Synthesis Program

Figure: Search Strategies

Objective #1 

Objective #2

Search results = 389 references Excluded = 379 references

Full articles pulled for review = 10 references Excluded = 7 references

3

8 Included = 11 references Identified by hand search = 8 references

Search results = 912 references

Full articles pulled for review = 4 references

Excluded = 908 references

Excluded = 4 references

Included = 1 reference Identified by hand search = 1 reference
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Examination in the Asymptomatic AdultEvidence Brief: Role of the Annual Comprehensive Physical

Evidence-based Synthesis Program

Procedure

Asymptomatic AdultsTable 1. United States Preventive Services Task Force (USPSTF) Recommendations for Physical Examination Procedures for Average Risk 

To detect... Grade# Year Comments

Blood Pressure (BP) Hypertension A 2007 For adults age 18 or older. There is no evidence on which to base a recommendation for optimal RECOMMENDED 

with BP 120-139 or diastolic 80-89. VA/DoD guideline (2004) recommends annual Pressure recommends every 2 years in persons w/ initial BP < 120/80 and every year in persons interval. The Joint National Committee on Prevention Diagnosis and Treatment of High Blood 

(Body Mass Index)Weight Obesity* B 2003 Frequency not specified; VA/DoD guideline (2006) recommends annualPAP smear Cervical cancer* A 2003 For women with a cervix every 3 years beginning within 3 yrs of onset of sexual activity or 

age 21 whichever comes first.

PAP smearRecommend AGAINST 

Cervical Cancer* D 2003 For women without a cervix or women over age 65 if they have had adequate screening in the 

past and are not at high risk of cervical cancer.

examinationWhole body skin Mouth examination Oral cancer* I 2004 Either for average or high risk (ie > age 50 who use tobacco) adultsINSUFFICIENT EVIDENCE 

Thyroid examination Thyroid Cancer* D 1996 “May contain information that is out of date” per USPSTF website accessed 8/31/11Abdominal palpation Pancreatic cancer D 2004Testicular examination Testicular cancer D 2011Pelvic examination Ovarian cancer* D 2004

Skin Cancer I 2009 Applies to general adult population. Does not apply to patients with a history of malignant or 

pre-malignant lesions or with familial syndromes associated with high risk.

Breast examination Breast Cancer I 2009 Insufficient evidence to recommend as an additional test for women who receive 

recommended mammography; see text page 4

Eye examination

acuityImpaired visual I 2009 For adults age 65 or older. 

Insufficient evidence that vision screening improves functional outcomesmacular degeneration or cataractsTests included Snellen eye chart, Amsler grid and/or fundoscopy to detect age-related 

Glaucoma* I 2005 Tests included Visual field exam, intraocular pressure and fundsocopic exam

Carotid artery auscultation Carotid artery Not RatedHearing Examination Hearing Loss* I 2011 For adults age 50 or older.

stenosis

NR 2007

screening for an asymptomatic bruit”; see text page 4JAMA Rational Clinical Exam (Simel 2009): “there are still no data that assess the effect of AngiographyGrade D for Ultrasound, Magnetic Resonance Angiography and Digital Subtraction 
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Examination in the Asymptomatic AdultEvidence Brief: Role of the Annual Comprehensive Physical

Evidence-based Synthesis Program

Procedure To detect... Grade# Year CommentsPeripheral pulse palpation Peripheral vascular 

disease

NR 2005 Grade D for screening w/ Doppler blood pressures which have “better accuracy than 

palpation of peripheral pulses”

Lung auscultation Chronic 

pulmonary diseaseobstructive 

NR 2008

accurate predictor of airflow limitation”;Grade D for screening spirometry; “good evidence that clinical examination is not an 

 JAMA Rational Clinical Exam (Simel 2009) states 

accurately assess severity of airflow obstructionthat no single component of the PE can rule in or rule out airflow obstruction and none could 

Abdominal palpation Abdominal aortic 

aneurysm

NR 2005 Grade B for one time screening by ultrasound in men age 65-75 who have ever smoked. 

Screening by ultrasound is superior to abdominal palpation which has poor accuracy. See text p. 4

# Grades A and B: Service should be offered or provided; Grade D: Use of this service should be discouraged; Grade I: Insufficient evidence to make a recommendation; NR: not rated; *Screening 

USPSTF recommendations from website accessed August 31, 2011 (recommendations for these conditions are currently being updated by the USPSTF; 

http://www.uspreventiveservicestaskforce.org) 

VA/DoD recommendations from website accessed September 8, 2011 (http://www.healthquality.va.gov)

Procedure

Table 2. Physical Examination Procedures Not Evaluated by the USPSTF (for Average Risk Asymptomatic Adults)

To detect... Recommendation/Comments Sources

PulseRECOMMENDED

Atrial fibrillation May be useful in adults over age 65 Fitzmaurice 2007

Heart auscultation Valvular disease

again at age 60*Recommended once at first adult exam and then once Oboler and LaForce 1989murmursNo data on indications for auscultation for systolic 

(Simel and Rennie, 2009)JAMA Rational Clinical Exam 

Lymph node palpationNOT RECOMMENDED

Malignancy Not recommended Oboler and LaForce 1989

Heart auscultation Coronary artery disease Not recommended Oboler and La Force 1989

Atrial fibrillation Not recommended Oboler and LaForce 1989 

Spleen/Liver palpation Hepato-splenomegaly Not recommended

(Simel and Rennie, 2009)JAMA Rational Clinical Exam Oboler and LaForce 1989

Assessment of spine mobility Risk for low back pain Not recommended Oboler and LaForce 1989Reflexes and sensation Peripheral neuropathy Not recommended Oboler and LaForce 1989Abdominal auscultation for bruit Renovascular hypertension Not recommended

(Simel and Rennie, 2009)JAMA Rational Clinical Exam 

Digital rectal examINSUFFICIENT EVIDENCE

Prostate or rectal cancer Insufficient evidence, see also text page 3 Oboler and LaForce 1989

Temperature/Respiratory rate Fever, tachypnea Insufficient evidence Oboler and LaForce 1989

*This recommendation is based on evidence from well designed cohort or case-control studies or controlled trials without randomization (Grade II, Oboler and LaForce, 1989, p. 215).