I'm afraid I was tearing my hair out reading Des Spence's article on chest examination this week! Physical examination is absolutely central to general practice. How else are we to make a working diagnosis? Just to provide a few examples of how chest examination has helped me in my practice: upper zone coarse crackles anteriorly ( psittacosis), abnormally forceful apex beat on palpation( late presentation of congenital heart disease)and reduced breath sounds R base ( pulmonary embolus). When I was a registrar, my trainer advised me to do a physical examination, however short, for every symptom the patient presented. It was brilliant advice and I'd encourage all new GPs to follow it.

Competing interests: None declared