Specificities of the Initial Physical Exam in Refugee Patients

SPECIFICITIES OF THE INITIAL
PHYSICAL EXAM IN REFUGEE PATIENTS

Due to multiple factors such as a language or education barrier, the medical history can sometimes be limited in refugee patients. This is why it is important to perform a complete physical exam in these patients in order to identify clinical elements that might have been missed on history. 

On the first visit, we usually perform a physical exam consisting of head and neck, cardiac, respiratory, abdominal and skin exams. As for the regular Canadian population, we do not perform routine genital, rectal or neurological exams in the absence of clinical indications. 
Some elements to consider when examining refugee patients: 

DENTAL EXAMINATION

Always perform an oral examination to look for obvious dental caries and significant oral disease. These patients should be referred to a dentist. Patients with poor dental health should also be counselled on adequate dental hygiene. 

HEART MURMURS

We often discover asymptomatic heart murmurs when examining refugee patients. These murmurs should always be investigated appropriately. Remember that the prevalence of rheumatic heart disease is a lot higher in low and middle-income countries (Watkins et al., 2017). 

POTENTIAL HISTORY OF 
PHYSICAL OR SEXUAL ABUSE

When performing a physical examination on a refugee patient, always remember that these patients might have suffered physical or sexual abuse in the past. There are also important cultural and religious aspects to consider. Thus, consent should always be obtained and the examination should be performed gently (especially genital exams). This is especially true for male practitioners examining female patients. We rarely perform a genital exam during the initial visit and usually postpone it to a subsequent visit if it is indicated.

HEPATOSPLENOMEGALY

Since multiple tropical illnesses can cause hepatosplenomegaly, the liver and the spleen should always be examined. 

SKIN EXAMINATION

We usually offer a general skin exam to look for skin infections (e.g. scabies), signs of violence or torture (e.g. burns, bullet wounds, old fractures, surgical scars) and signs of physical abuse in children (e.g. multiple bruises in a pre-mobile child, bruising to the ear/neck/torso/buttocks, sharply demarcated burn marks, oral injuries). Keep in mind that some patients might not be comfortable with this exam and consent should always be obtained beforehand. Physical findings should be carefully documented in the chart. This is especially important for refugee claimants since physical exam findings can play a significant role in their claim process.
Share by: