Clinical examination is essential to reduce overdiagnosis and overtreatment

During a recent cardiology ward round, the consultant listened to a patient’s heart and described a harsh mid-systolic ejection murmur with a very quiet S2, on top of a higher pitched pan-systolic murmur heard best over the apex, with P2 being more audible than normal. To me this was uninterpretable. He postulated that the patient had severe aortic stenosis with moderate mitral regurgitation. Subsequent review of the echocardiography report confirmed that he was spot on. To me this was intellect and perspicacity at its most beautiful. Those with a more sceptical outlook may suppose that he had furtively inspected the echocardiography report beforehand.

Occasionally in the preceding weeks, I had found myself assessing patients and wondering whether it was worth listening to the heart and lungs if at first glance I knew that I was going to order an echocardiogram and chest x ray examination. During a hectic and time pressured on-call shift …