Non-medical prescribers are health care professionals, such as nurses, pharmacists, paramedics, and physiotherapists, who have the legal authority to prescribe medicines for patients within their scope of practice. Non-medical prescribing can improve patient access, satisfaction, and outcomes, as well as reduce the workload and costs of medical prescribers. However, non-medical prescribing also requires high levels of competence, confidence, and accountability from the prescribers. One of the essential skills that non-medical prescribers need to have is the ability to conduct a competent physical examination and take a structured history from a patient.
Physical examination is the process of evaluating the physical condition of a patient by using observation, palpation, percussion, auscultation, and smell. History taking is the process of obtaining relevant information from the patient or other sources about their symptoms, medical history, medication use, allergies, lifestyle, and psychosocial factors. Physical examination and history taking are complementary and interrelated processes that form the basis of clinical assessment and diagnosis2.
Non-medical prescribers need to be able to perform physical examination and history taking skills for several reasons:
- To ensure safe and effective prescribing. Non-medical prescribers need to gather sufficient and accurate data from the patient to make informed decisions about their diagnosis, treatment, and follow-up. They need to identify any contraindications, interactions, or adverse effects that may affect their prescribing choices. They also need to monitor the patient’s response and adherence to the prescribed medicines.
- To comply with professional standards and regulations. Non-medical prescribers need to follow the guidelines and codes of conduct of their respective professional bodies and regulators. For example, the General Medical Council (GMC) states that prescribers must carry out a physical examination of patients before prescribing non-surgical cosmetic medicines. The Nursing and Midwifery Council (NMC) states that prescribers must have or take an adequate history before prescribing any medicines5.
- To enhance patient-centred care. Non-medical prescribers need to establish rapport and trust with the patient by communicating effectively and respectfully. They need to explain the purpose and procedure of each technique and obtain informed consent from the patient. They need to respect the patient’s privacy and dignity and use appropriate draping techniques. They also need to provide health education and counselling to the patient.
To develop and maintain their physical examination and history taking skills, non-medical prescribers need to have adequate training and practice. They also need to update their knowledge and skills regularly by engaging in continuing professional development (CPD) activities. One of the ways that non-medical prescribers can improve their skills is by attending a five-day patient assessment skills workshop offered by Practitioner Development UK (PDUK). This workshop provides practitioners with a springboard for diagnostic proficiency and clinical decision making. After studying basic history taking and physical examination techniques, participants will have the opportunity to perform a complete physical examination reflecting clinical practice requirements and helping to develop all-round confidence. The course mainly focuses on the adult patient, general history taking and systematic physical examination. Further expertise is developed in the workplace with an appropriate facilitator who can then look at areas that are specific to individual practice. Completion of this course does not qualify the attendee as an advanced practitioner but is the first step in expanding practice, leading to a more autonomous role.
Another way that non-medical prescribers can enhance their physical examination skills is by reading an article on different types of physical examination techniques published by PDUK on their website. This article provides an overview of the four basic methods or techniques that are used for physical examination: inspection, palpation, percussion, and auscultation. It also explains how these techniques are applied to different body systems and organs, such as the skin, hair, nails, eyes, ears, nose, mouth, throat, neck, chest, abdomen, extremities, and genitals. It also gives some tips on how to perform these techniques effectively and accurately.
In conclusion, physical examination and history taking are vital skills for non-medical prescribers that can help them ensure safe and effective prescribing, comply with professional standards and regulations, and enhance patient-centred care. Non-medical prescribers can enhance their skills by attending a five-day patient assessment skills workshop offered by PDUK or reading an article on different types of physical examination techniques published by PDUK on their website.
