Physical examination and investigations in psychiatry

Meet the patient — and the registrar's relief

A 24-year-old man is brought in agitated, mute, and febrile after a week of flu-like illness. The registrar writes "psychiatric admission, medically cleared" on the strength of a normal set of obs taken three hours ago. By the time you reach the bed, his attention is fluctuating and his CK is rising.[16][1]

"Medically cleared" is not a clearance — it is a timestamp. Every examiner favourite in this topic (excess cardiometabolic mortality, drug-induced QTc, missed encephalitis, missed delirium) is preventable with a disciplined exam and monitoring plan, and every one of them is fatal if you skip it.[4][5][6][16]

Etymology for viva gold: iatrogenic, from Greek iatros, "physician", plus genesis, "origin". Half of the harm this topic exists to prevent is the harm our own prescriptions cause — which is why monitoring is the intervention, not the paperwork.[6]

References21Show ledgerHide ledger

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