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The Physical Examination is Critical for Proper Care

Posted Monday, December 31, 2018 by Morgan Cartwright

It’s estimated that hospitalists and internal medicine interns spend less than 18% and 12%, respectively, of their time in direct patient care. Most of this is due to an increased reliance on diagnostic technology, lack of bedside teaching, and decreased interest in physical examination due to time limitations. As a result, patients’ care may be mismanaged, sometimes leading to significant risk of harm.

In one case study, the doctor describes a patient who goes to the emergency department for left-sided facial paralysis. The doctor ordered a CT that offered no diagnostic clues, and the patient was diagnosed with bells palsy. The next day, the patient returned with arm weakness. A thorough physical examination at that time discovered the patient’s forehead muscles were unaffected, making the diagnosis of bells palsy less likely.

Furthermore, the doctors were able to get at the issue by getting the patient to admit to daily heroin injections, despite having previously denied it. At this point specialists were able to evaluate him with an echocardiogram, which showed vegetation on his mitral valve. He then underwent emergent mitral valve replacement surgery to prevent recurrent embolic strokes.

This case illustrates that the initial examination on the first day should have been more thorough to prevent later complications.

While technology certainly has its place in the modern diagnosis of a patient, a thorough physical examination is also important. The advantages of being thorough include positive physician-patient relationship, improved patient safety, fewer diagnostic errors, and lower financial costs.

Importance Of Thorough Physical Examination: A Lost Art

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