Editorials Christmas 2009

In praise of the physical examination

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b5448 (Published 16 December 2009) Cite this as: BMJ 2009;339:b5448
  1. Abraham Verghese, professor and senior associate chair for the theory and practice of medicine,
  2. Ralph I Horwitz, chair of the department of medicine and Arthur Bloomfield professor of medicine
  1. 1Department of Medicine, S102, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5110, USA
  1. abrahamv{at}stanford.edu

    It provides reason and ritual

    If an alien anthropologist were to visit a modern teaching hospital, “it” might conclude that, judging by where doctors spend most of their time, the business of an internal medicine service takes place around computer terminals. The alien might assume that the virtual construct of the patient, or the “iPatient”,1 is more important than the flesh and blood human being occupying the bed.

    But the alien would be wrong—patients are what medical care is all about. Yet the electronic medical record and advanced imaging technology have not only seduced doctors away from the bedside but also devalued the importance of their role there. Indeed, intensive care units exist where consultants conduct their “rounds” on the patients and adjust ventilator settings and drugs via telemetry.2

    These trends have left educators and trainees in internal medicine in two camps when it comes to the merits of the bedside examination. In the first camp are those who pine for the old days, bemoan the loss of clinical bedside diagnostic skills, and complain that no one knows Traube’s space or Kronig’s isthmus. In the second camp are those who say good riddance and point out that evidence based studies show that many physical signs are useless; some might even argue that examining the patient is just a waste of time.

    We believe that the truth is somewhere in between. We argue that clinicians who are skilled at the bedside …

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