Small animal consultations: What is the role of the clinical examination?

Natalie Robinson1*; Marnie Brennan, BSc (VB), BVMS, PhD1; Malcolm Cobb1 and Rachel Dean, BVMS PhD DSAM (Fel) MRCVS1

[1] School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Sutton Bonington, Loughborough, Leicestershire LE12 5RD, United Kingdom
* Symposium speaker

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Detecting disease before the onset of clinical signs can lead to improved management of conditions, and clinical examination may play a role in this early detection. Previous research has found clinical examination to be useful in detecting underlying disease during vaccination consultations and geriatric screening consultations. However, little is known about the wider role of the clinical examination during veterinary consultations. It is unclear how elective clinical examination is in the early detection of disease and also whether this results in improved longer term outcomes. The aim of this study was to describe clinical examination practices during first opinion small animal consultations.

A data collection tool was developed to gather information by direct observation of consultations. Data were gathered in eight sentinel practices with two weeks spent at each practice. Type of clinical examination performed was categorised into full, focused or none. Any clinical examination abnormalities identified were recorded. Data were also gathered on the type of consultation, which was categorised into first consultation, revisit, preventive medicine or elective euthanasia. Patient signalment was recorded and included species, breed, age, sex and neutering status. The number of problems discussed were also recorded.

Data were recorded for 1889 patients. A full clinical examination was performed for 60.6% (n=1145) of patients and a focused examination for 31.4% (n=594). No clinical examination was performed for 7.9% (n=150). Of the 1739 patients who received a full or focused examination, 1343 (77.2%) had at least one clinical examination ab- normality detected. Clinical examination type varied significantly be- tween practices (pi0.001), consultation types (pi0.001) and species (pi0.001). Full examinations were performed most frequently in preventive medicine consultations and consultations involving feline patients. Significantly more problems were discussed when a full compared with a focused examination was performed (pi0.001). A median of 3 problems were discussed for patients receiving a full examination while a median of 1 problem was discussed for patients receiving a focused examination.

Clinical examination was frequently performed and may be a useful tool in the detection of underlying disease. Differences seen between consultation types, practices and species may reflect diferences in time constraints, practices policies and ease of clinical examination in some species. Understanding why these differences occur could allow changes to be made which result in improved detection of sub-clinical disease. However, full examination of every patient may not be practical or necessary, and could lead to over-diagnosis and un- necessary treatment. Future work could focus on identifying patient groups where more thorough examination will lead to improved outcomes, to allow an evidence-based approach to clinical examination during the consultation.

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