Patient factors that may contribute to a poor exam:
(1) intoxication
(2) combative or psychotic
(3) comatose or unable to give complaints
(4) dirty and foul-smelling
Conditions in the Emergency Department contributing to a poor exam:
(1) overcrowding
(2) critical cases present
(3) disaster
Failures on the physical examination:
(1) not carefully examining an area covered by hair
(2) not washing an area that is dirty
(3) not removing all clothing
(4) not examining under a dressing or cast
(5) not examining the genital region
(6) not performing a rectal exam
(7) not spending enough time
(8) fixating on an obvious injury or complaint
(9) ignoring some part of the exam
Failures on the imaging studies:
(1) wrong imaging study ordered
(2) failure to perform the necessary view to see an injury
