Clinical examination
Governing: Table A-VI/4-2, criterion 'identification of symptoms is based on the concepts of clinical examination and medical history'; RCP NEWS2 Chart 1; MGN 623.
History first
Most diagnoses are made from the history. Take it in a quiet place, with privacy, and with a chaperone for intimate examinations or when the patient prefers one.
| Element | Ask |
|---|---|
| Presenting complaint | What is wrong, in their words |
| History of the complaint | When, how it started, how it has changed, what makes it better or worse |
| For pain | Site, onset, character, radiation, associated symptoms, timing, severity out of ten |
| Past history | Previous illnesses, operations, the last time this happened |
| Medicines | Prescribed, over the counter, supplements, recreational |
| Allergies | Especially to medicines in the chest |
| Social | Alcohol, smoking, recent shore leave, travel, sexual history if relevant |
| For women | Possibility of pregnancy, last period |
Ask open questions, then closed ones to clarify. Write it down as you go.
Examination
Work systematically, head to toe, comparing sides:
- General: how unwell do they look, colour, sweating, posture, breathing effort.
- Head, eyes, ENT: pupils, eye movements, throat, ears.
- Chest: breathing rate and effort, symmetry, cough, sputum.
- Abdomen: where it hurts, guarding, rigidity, swelling (acute abdomen is in the A-VI/4-2 list for a reason: appendicitis on passage is a classic evacuation case).
- Limbs and skin: swelling, rashes, wounds, circulation.
- Neurological: level of consciousness, speech, limb power, sensation.
Vital signs
The RCP NEWS2 chart is the UK standard for spotting deterioration. It scores six parameters, and the bands that score 0 are a practical reference for 'normal' in an adult:
| Parameter | Scores 0 |
|---|---|
| Respiration rate | 12-20 per minute |
| SpO2 (scale 1) | 96% or more |
| Systolic BP | 111-219 mmHg |
| Pulse | 51-90 per minute |
| Consciousness | Alert |
| Temperature | 36.1-38.0 C |
Anything outside those bands earns points, and new confusion scores highly on its own. You do not need to calculate NEWS2 to use it; what matters is spotting several abnormal signs together and a worsening trend.
Technique points: count breathing for a full minute without telling the patient; take the pulse for a full minute if irregular; use the pulse oximeter on a warm finger without nail varnish; take temperature by the method in the ship's kit and note which.
Recording and reporting
Use an observation chart with times. Repeat observations at intervals agreed with TMAS. MGN 623 notes the SCMG includes a proforma for the information the TMAS doctor needs and that photographs help.
WARNING — Sepsis looks like flu at first A fast pulse, fast breathing, high or low temperature and new confusion in someone with an infection is an emergency. Do not wait for the morning.
TIP — Baselines Some yachts record each crew member's resting pulse and BP at joining. It makes 'is this normal for him?' answerable at 0300.