Quote:
Originally Posted by logos
Agree. Very little real utility. I do it when indicated but no nearly as often as others. For example, there is a practice at our place of doing DRE on every patient prior to starting anticoagulation. Insanity. We also still do them on our trauma patients where there is much evidence that they add nothing to the evaluation (and were made optional in the new ATLS for that reason).
|
A hemmoccult has never changed my management. If they are elderly with "dark stool" epigastric pain, or anemia they need admission and scope, regardless of what a hemmocucult would show. We have some absolutely insane docs who insist on doing them on STEMI patients before starting Heparin or Plavix. Insanity I say!
Quote:
|
I feel the same way about pelvics. The only thing I really care about most of the time is the bimanual, the speculum exam adds little to the "STD check" that is our most common indication.
|
Agreed with this two. There is no utility on most of the pregnant "spotters" or stable vag bleeder. I'll only do it now for people complaining of serious bleeding, or severe low abdominal pain with no etiology based on the other tests.
Quote:
|
The physical exam itself is dying a slow death. Most maneuvers taught in medical school have little utility. I highly reccomend JAMA's "The Rational Clinical Examination" series.
|
You mean you don't use Psoas and Obturator signs daily in your clinical practice for belly pain?