Facial expression

Facial expression, including the presence or lack of eye-to-eye contact, is a useful index of physical and psychological well-being (see Table 2.2).

Iron Blue Sclera

Fig. 2.1 Examples of the value of 'spot diagnoses. El Blue sclera In a patient with osteogenesis Imperfecta. E Scleroderma facies with 'Peaking' of nose and taut skin around mouth. BE The facies In acromegaly. S] Leg of elderly male with scurvy showing large ecchymosis In thigh ('woody leg ) with perifollicular haemorrhages in calf.

Fig. 2.1 Examples of the value of 'spot diagnoses. El Blue sclera In a patient with osteogenesis Imperfecta. E Scleroderma facies with 'Peaking' of nose and taut skin around mouth. BE The facies In acromegaly. S] Leg of elderly male with scurvy showing large ecchymosis In thigh ('woody leg ) with perifollicular haemorrhages in calf.

The recognition of the looks of pain, fear, anxiety, anger or grief does not require medical training but should alert the clinician to explore the underlying emotional issues. Some patients may manage to conceal their apprehension or cloak their feelings in an air of feigned cheerfulness. The doctor should avoid adopting, or being misled by, such an apparently lightheaded attitude. The experienced clinician behaves naturally and thereby reduces risks of misunderstanding.

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