Saturday, August 6, 2016

Clinical examination nowadays

I am a retired physician and teacher. I studied medicine and taught it with a strong emphasis on taking the history of patients and physical examination before diagnosis. I have told my students that in more than half of patients, the history is the main determinant of the diagnosis. With the gradual shift of emphasis towards technology, I now see doctors facing the patient with a laptop in front of them, asking few questions then, with a limited or no physical examination, handing the patient a long list of tests to be done in the laboratory and various imaging facilities. I realise that the information obtained from properly chosen laboratory and imaging tests can be more accurate and more objective than information obtained through interrogation and physical examination. But, the proper choice of tests depends on a good differential diagnosis based on a good history and physical examination. Irrelevant tests are a waste of time and money, place an unnecessary burden on the patient, are a possible cause of side-effects that can sometimes be serious, and a cause of delay to other patients who actually need these tests. Moreover, interpretation of the test results depends on the probability of the condition you are testing for. The predictive value of a test varies with the pre-test probability of the disease, which in turn depends on the information obtained from the history and physical examination.
Moreover, careful questioning and examination strengthens the doctor–patient relationship, builds a patient's confidence in their doctor, and makes them feel that their doctor cares. The importance of doctor–patient communication for a person whose life and wellbeing depend on this relationship cannot be overemphasised.
I declare no competing interests.