Inspection is the systematic process of observing a patient using only the sense of sight to gather objective information about their health status. This technique begins the moment a healthcare provider first encounters the patient and continues throughout the assessment. It involves a focused look at the patient’s general presentation, body systems, and specific areas of concern. The objective data collected establishes the visual baseline against which all subsequent findings from the physical examination will be compared.
Inspection as the Foundational Step of Physical Examination
Inspection is the initial step in the complete physical examination sequence. Medical training often uses the mnemonic IPPA—Inspection, Palpation, Percussion, and Auscultation—to establish the standard order of these four techniques. This sequencing is designed to ensure the integrity of the objective data being collected.
By performing inspection first, the clinician gathers information without physically disturbing the patient’s body or altering any existing physical signs. Subsequent techniques, such as palpation (touching) or percussion (tapping), can inadvertently change findings; for example, they might cause temporary localized redness or alter the frequency of bowel sounds. Therefore, visual assessment must precede any physical contact to prevent the disturbance of visual clues.
The primary exception to the IPPA sequence occurs when examining the abdomen, where auscultation is performed immediately after inspection. This modification is necessary because palpation or percussion of the abdomen can stimulate peristalsis, artificially increasing or changing the character of the bowel sounds. In all other body systems, inspection relies on visual observation, while the other three techniques require the senses of touch or hearing to obtain information about internal structures and function.
Principles and Techniques of Visual Assessment
Effective inspection relies on a systematic methodology and the proper clinical environment. Adequate lighting is paramount, often requiring good overhead illumination combined with tangential lighting. Tangential lighting, cast at a low angle across a surface, helps accentuate contours, subtle pulsations, and slight elevations or depressions, making minute irregularities easier to detect.
The assessment requires comparing one side of the body with the other to evaluate symmetry. A clinician observes key visual parameters, including the color of the skin and mucous membranes, looking for abnormal hues like pallor (paleness), erythema (redness), or cyanosis (bluish tint). Size and shape of structures are noted, along with involuntary movements or tremors.
Posture and gait are assessed as part of the general appearance, providing immediate clues about comfort and neurological status. Specialized instruments are sometimes required to extend the range of vision, such as an otoscope for inspecting the ear canal and eardrum, or an ophthalmoscope for viewing the internal structures of the eye. The visual assessment must be conducted with the patient appropriately draped and positioned to allow viewing of the body area being examined.
Application Across Body Systems
Inspection yields findings across different organ systems. In the integumentary system (skin), inspection focuses on identifying rashes, lesions, changes in mole characteristics, or localized areas of swelling known as edema. For the head and neck, a provider checks for signs of jugular vein distention, which can suggest increased pressure in the cardiovascular system, or obvious enlargement of the thyroid gland.
During an abdominal assessment, inspection involves noting the general contour, looking for distention or scaphoid (sunken) appearance, and observing the skin for surgical scars or visible peristalsis (wave-like muscle contractions). Inspection of the extremities includes checking for finger clubbing, which is associated with chronic respiratory or cardiac conditions, or joint deformation indicative of arthritis. These system-specific visual clues help guide the subsequent steps of the physical examination and focus the diagnostic process.