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FRISKING - IT SHOULD BE PRACTISED BYA GP IN ADDITION TO CUSTOM OFFICIALS
OP KAPOOR
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
Those of you, who have been doing air travel, must have noticed that at the airports, during the security check, the custom officials `frisk' you from top to bottom, to check whether you are carrying any weapon. I have undergone this procedure a number of times, where the person palpates from top to bottom and often he has touched my perineum, groins and scrotum. And why not? Because this is his very responsible duty.
I want to draw the attention of the GPs, that unless a thorough history is taken and a good `general' examination carried out, the diagnosis can be missed.
This general examination should be mainly in the form of seeing and feeling the patient from top to bottom. The only difference is with the bottom. In medical terms, this should be defined as the perineum and the genitals and not the feet. A number of patches of silent Hansen's, neurofibromas and many other conditions are missed, due to inadequate examination which is nothing less than `frisking', practised at the airports.
In fact, after the recent episode in USA, the officers have started examining the bottom more carefully, because recently, one of the terrorists had hidden a weapon in the shoes. Similarly, I will remind the practitioners that in any patient, who complains of pain in the legs, the feet and the shoes should be examined in detail. Very often, the arch of the foot or the bad shoes with odd heals, reveal the cause of leg pains.
I can now see the "future" role of the custom officials. People are learning to hide drugs like heroin in the stomach or the rectum and the time is not far, when the custom officials will be examining both these ends at the airport. This is just to remind the practitioners that, short of endoscopy, do not forget to open the mouth, lest you miss half a dozen conditions, which may or may not be connected to the presenting illness.
Similarly, the rectal examination is often omitted, because the doctor feels, he might spoil his hands by touching this filthy area, should not be forgotten.
Hiding the weapon in the underwear or brassiers (in case of females) is very common and thus these areas are included in the frisking.
A lesson for the GPs is to examine and palpate the breasts in all patients, to exclude silent tumours and to examine the scrotum and the genitals in order to identify a number of illnesses. More important is that the patient feels satisfied, for getting examined thoroughly.
Future will show whether the custom officials will come to the doctors to learn the method of frisking or the doctors will learn from them. If you are good in `frisking', you will be a better family physician.
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