Views & Reviews From the Frontline

Bad medicine: chest examination

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e4569 (Published 04 July 2012) Cite this as: BMJ 2012;345:e4569
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}yahoo.co.uk

Respiratory and cardiac assessment are central to clinical examination. As a student I always agreed that I had heard murmurs, crepitations, and rubs, even when I hadn’t. Good doctors found signs, and I didn’t want to look stupid. When I started work I noticed that colleagues changed their recorded findings after chest radiography; signs moved from left to right, and effusion appeared where none was recorded before. Good doctors were cheating, and in the real world I missed pneumothoraces, heart failure, embolisms, and effusions on clinical examination. What I had …

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