Views & Reviews From the Frontline

Bad medicine: clinical breast examination

BMJ 2012; 345 doi: (Published 11 October 2012) Cite this as: BMJ 2012;345:e6789
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

To question clinical examination is to open a rich vein of debate. Clinical examinations are unquestioned, given disproportionate weight, and considered “must do.” Not doing a full examination implies you are a bad doctor. But much of examination is mere ritualistic dogma passed down through the ages. Examination would never pass modern assessments of predictive value. Is this so for clinical breast examination (CBE)?

For CBE, I was taught that the patient should be exposed from the chest down, examined in various positions, and palpated with the three central fingers in the various quadrants, and …

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