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Guidelines and discussion of the history and physical examination
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Description:Over 600,000 refugees have resettled in the United States over the past decade, with a steady increase in numbers since 2006 [1]. Refugees arrive from around the globe and settle throughout the United States. Depending on their country of origin, refugees are at increased risk for many diseases, both infectious and noninfectious, not commonly seen in the native US-born population. Conditions such as tuberculosis and sexually transmitted infections are particularly important to recognize early, given their potential public health consequences.
The initial history and physical (H&P) examination is a critically important first step in the assessment of newly arrived refugees. A thoughtful H&P can both assist in identifying disease and help refugees develop a sense of trust in our medical system and in the care being provided (e.g., in many cultures a clinical encounter is viewed as useless if a physical examination is not performed during the visit). Given the complexity of the domestic medical screening visit, it is vital that clinicians set aside an adequate amount of time, create a trusting environment, and provide competent interpretation services to facilitate compassionate and culturally appropriate history acquisition and performance of the physical examination.
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