There has been a lot of discussion in the medical blogs recently about the usefulness (or lack) of physical examination.I personally think that physical exam is very important but when "the HMOs force physicians to care for a maximum number of patients, in a minimum number of minutes for the lowest number of dollars" something has to give...
One of the comments on KevinMD says that clearly: "Why do I have the feeling this guy never had to see 40 patients a day at 15-minutes per encounter... I bet his physical exams would leave a lot to be desired at that rate."
Anyway, if you want to refresh your skills, you can review this large collection of free physical examination videos organized by body system.
Update 3/23/2007:
Dr. Wes comments on "Procedural Darwinism":
Take the stethoscope, for instance. It is rapidly succumbing to Procedural Darwinism. If it weren’t for the stethoscopes ability to hear breath sounds, it would have been extinct long ago. The echocardiogram is far superior to “hear” heart sounds, and adds procedural survival protection by providing additional size, structure, and functional information regarding the heart with little pain or toxicity to the patient. The echo also reimburses well.
Further reading:
Hyposkillia. Deficiency of Clinical Skills. Herbert L. Fred, MD, MACP. Tex Heart Inst J. 2005; 32(3): 255–257.
Comments about deficiency of clinical skills. Retired doc's thoughts.
Declining clinical skills. Notes from Dr. RW.
An old-timer bemoans the demise of the physical exam, or hyposkillia. KevinMD.
The Danger of Being "Too Fast"
In defense of clinical skills. Notes from Dr. RW.
What does the evidence say about clinical skills? Notes from Dr. RW.
Time, Now, to Recover the Fun in the Physical Examination Rather Than Abandon It. Arch Intern Med. 2006;166:603-604.
Imagine: Physical Exam Can Save Lives. Dr. Wes, 08/2007.
The Physical Exam Can Be Pretty Important, Part 2. Dr. Val and The Voice of Reason, 03/2008.
Mourning the loss of basic clinical skills. Notes from Dr. RW, 2009.
Updated: 09/09/2009
I can't believe there haven't been any comments posted about this subject. People wonder why going to the doctor has become so expensive. One of the reasons is the rampant over-reliance on high tech investigations of diseases and disorders which can more appropriately be diagnosed at the bedside. This is no small point, physical exam and history are necessary and often sufficient to diagnose a disease. Imaging and labs are there to confirm those impressions. I don't trust any physician who does not do a physical exam on me and I tell them so when I meet them. Physical exam is fundamental to the physician patient encounter.If you can't use a stethoscope to listen to my heart, lungs, abdomen and carotid pulses and know what you are hearing then get away from me junior.
ReplyDeleteThe bigger question is does Physical exam is the only way available for medical learning. can there be other options available. Time is precious but that does not mean that one should handle patients beyond its capacity.
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