Dr Amir Khan has explained a test he and other GPs carry out on every patient they see, beginning the moment the patient walks into his office. The well-known TV doctor said he starts observing patients from the moment they 'walk through the door' rather than waiting for them to describe their symptoms.
What is the 'end-of-the-bed assessment'?
Dr Khan said he is not alone in this approach - many GPs reportedly use it, and it is known as the 'end-of-the-bed assessment'. While it does not replace clinical tests, it often provides the first clue as to what the problem might be.
He explained: "As a GP, I've actually started examining you before you've even sat down in my room. Not deliberately, it's just something we learn to do. The first thing I might notice is how a patient walks into the room. Are they walking normally? Are they limping? Are they shuffling? Are they holding on to furniture? How quickly can they move from the waiting room down the corridor into my room? That can give me clues about pain, muscle strength, balance and neurological problems."
Clues from sitting, breathing, and appearance
Dr Khan also observes how patients sit down and get back up, noting that using arms to push out of a chair, especially if new, can indicate reduced muscle strength or joint or neurological issues. He checks breathing while the patient talks, looking for breathlessness, unusual speed, or use of extra muscles around the neck or shoulders. He also examines the face and skin for paleness, flushing, sweating, or yellowing, and checks lip colour.
One of the most important observations, he said, is comparing the patient to their normal self. "Sometimes a relative will say, 'Well, he's just not himself.' And that sentence can be incredibly important, particularly in older people. A change in alertness, speech, behaviour, or confusion can sometimes be one of the first signs that someone is unwell."
NHS advice for GP appointments
The NHS website advises patients to prepare for appointments by noting things to discuss, mentioning any medicines, preparing questions, and being ready to talk until they understand the situation. It also suggests bringing someone for comfort and not being afraid to ask for clarification on medical terms. Patients should check their list before leaving and book any needed appointments promptly, as well as asking about support groups, reliable information sources, and copies of letters written about them.
Dr Khan concluded: "When you come into my consulting room, yes, I'm listening to your symptoms, but I'm also watching how you walked in, how you're breathing, how you're moving, how you're interacting with me, because some of those things are just as important as what you're telling me or any test that I can order. Because the body's started telling me the story before the patient even starts talking to me."
He added: "Of course, observation never replaces listening to the patient, examining them or doing the appropriate tests. But sometimes the first clue to what's going on arrives before the first word does."
