- Joined
- Aug 15, 2003
- Messages
- 28,059
- Reaction score
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[pessimism]
I think the physical exam needs its own thread, because simply I am tired of it. It doesn't do what it needs to do, and everything that is found is so subjective and nonspecific that it might be better off if it was eliminated. Near as I can tell, the only purpose the physical exam serves is to reassure the patient that the physician or student is carefully paying attention to their physical state and assessing the need for treatment.
I must admit that certain aspects of the physical exam are important. The vital signs are key. But these can be done by a machine or a nurse and most physicians don't do them anyway. Examining the skin is also important, but at the same time describing findings is so difficult that unless you are the one deciding on the treatment, it is basically not helpful to do.
Listening to the lungs? Fine, go ahead, but if the patient is short of breath they are going to get an xray or cat scan anyway. Heart? Sure, but if they have a fever, they generally get blood cultures and if it persists they get an echo regardless of murmur. Abdominal? Useless except to find an acute abdomen, and even then it isn't that helpful. Neuro exam? Listen to the patient, they'll tell you what your findings are going to be. You say your arm is weak? Wow, my physical exam suggests that as well!
I shouldn't be so anti-physical exam. After all, it is important for doctors to be able to correlate patient complaints and symptoms with a unifying diagnosis. But labs and films always seem to help more. Sometimes people will say, "that's a classic physical exam finding" but yet they always have to confirm it with a film or a test, because it's not specific. And if a lab test or a film keeps telling you something isn't there, but the physical exam keeps telling you something might be, which one do you trust?
I know, I know, people are going to come up with ways in which the physical exam is vitally important, and it is irresponsible of me to think like this. So be it. A good history is much more important in almost every situation. Some diagnoses can't be made without a good physical exam, I know. But most of these (otitis media, pharyngitis) are visual or the history is even more effective.
Plus, I think the physical exam is a large reason why so many hospitalized patients end up with MRSA or VRE colonization. Too many doctors who want to feel their belly.
I still have 2 weeks of ID and 4 weeks of neurology left. Many more days of the stethoscope, reflex hammer, blah blah blah. I've learned what I can. Get me to residency.
R.I.P. Physical Exam. We knew ye well. But ye be outdated and other modalities be more helpful. Besides, as pathologists, we don't really care about you.
[/pessimism]
I think the physical exam needs its own thread, because simply I am tired of it. It doesn't do what it needs to do, and everything that is found is so subjective and nonspecific that it might be better off if it was eliminated. Near as I can tell, the only purpose the physical exam serves is to reassure the patient that the physician or student is carefully paying attention to their physical state and assessing the need for treatment.
I must admit that certain aspects of the physical exam are important. The vital signs are key. But these can be done by a machine or a nurse and most physicians don't do them anyway. Examining the skin is also important, but at the same time describing findings is so difficult that unless you are the one deciding on the treatment, it is basically not helpful to do.
Listening to the lungs? Fine, go ahead, but if the patient is short of breath they are going to get an xray or cat scan anyway. Heart? Sure, but if they have a fever, they generally get blood cultures and if it persists they get an echo regardless of murmur. Abdominal? Useless except to find an acute abdomen, and even then it isn't that helpful. Neuro exam? Listen to the patient, they'll tell you what your findings are going to be. You say your arm is weak? Wow, my physical exam suggests that as well!
I shouldn't be so anti-physical exam. After all, it is important for doctors to be able to correlate patient complaints and symptoms with a unifying diagnosis. But labs and films always seem to help more. Sometimes people will say, "that's a classic physical exam finding" but yet they always have to confirm it with a film or a test, because it's not specific. And if a lab test or a film keeps telling you something isn't there, but the physical exam keeps telling you something might be, which one do you trust?
I know, I know, people are going to come up with ways in which the physical exam is vitally important, and it is irresponsible of me to think like this. So be it. A good history is much more important in almost every situation. Some diagnoses can't be made without a good physical exam, I know. But most of these (otitis media, pharyngitis) are visual or the history is even more effective.
Plus, I think the physical exam is a large reason why so many hospitalized patients end up with MRSA or VRE colonization. Too many doctors who want to feel their belly.
I still have 2 weeks of ID and 4 weeks of neurology left. Many more days of the stethoscope, reflex hammer, blah blah blah. I've learned what I can. Get me to residency.
R.I.P. Physical Exam. We knew ye well. But ye be outdated and other modalities be more helpful. Besides, as pathologists, we don't really care about you.
[/pessimism]
"...hold on a second, Mr. Smith; let me douse you in clorox before we begin..."
