Has Medicine Outgrown Physical Diagnosis?

Fletcher, Robert H.

doi:10.7326/0003-4819-117-9-786

Cited by 48 publications

(24 citation statements)

References 6 publications

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“…In the previously mentioned studies that suggest a low incidence of S3 detection in heart failure, it is possible that the physicians may have been unable to detect a sound that was truly present. Recent studies indicate that physicians are becoming less proficient at performing the physical examination, and physicians in residency programs have been shown to have poor cardiac auscultatory skills [33][34][35][36][37]. Furthermore, inter-observer agreement of S3 detection is poor, with board-certified cardiologists having no better agreement than house staff [38][39][40].…”

Section: Significance Of S3 and S4 Detection In Heart Failurementioning

confidence: 95%

The third heart sound for diagnosis of acute heart failure

Johnston

Collins²,

Storrow³

2007

Curr Heart Fail Rep

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Dyspnea is a common presenting complaint in the emergency department (ED). Rapid identification of heart failure as the etiology leads to early implementation of targeted therapies. Although having only intermediate sensitivity, the S3 is a highly specific finding among older adults with heart failure. Identification of an S3 by routine auscultation can be problematic given the chaotic and noisy ED environment, patient comorbid conditions, and intolerance of ideal positioning for auscultation. Technologies using computerized analysis of digitally recorded heart tones have recently been developed to aid the clinician with bedside detection of abnormal heart sounds. Data using these technologies and their applications in the ED are reviewed as well as implications for future use and research.

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Section: Significance Of S3 and S4 Detection In Heart Failurementioning

confidence: 95%

The third heart sound for diagnosis of acute heart failure

Johnston

Collins²,

Storrow³

2007

Curr Heart Fail Rep

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“…There is a growing concern, however, regarding deficiencies of physical examination skills among graduate medical trainees. 1,2 As suggested in the literature, these deficiencies may result from the limited amount of bedside teaching provided to physicians in training 3 and the reliance on new technologies to diagnose the patient. 2 The positive aspects of teaching bedside physical examination include role modeling professional behavior, teaching the human dimension of medical practice including good communication skills, and demonstrating real-life physical examination findings.…”

Section: Introductionmentioning

confidence: 97%

Effect of Bedside Physical Diagnosis Training on Third-Year Medical Students' Physical Exam Skills

Roberts

et al. 2014

Teaching and Learning in Medicine

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“…The medical literature has long issued periodic warnings of the demise of physical examination (PE), primarily as a result of emerging technologies and decreased bedside teaching (Fletcher & Fletcher 1992;LaCombe 1997;Flegel 1999;Jauhar 2006). While it is clear that PE can be an important diagnostic tool when used in an evidence-based fashion (Sackett 1992;Ende & Fosnocht 2002;Reilly 2003;Joshua et al 2005), a survey of internal medicine faculty, housestaff, and third-and fourth-year medical students showed significant heterogeneity in confidence with examination skills, as well as in the perceived utility of these skills (Wu et al 2007).…”

Section: Introductionmentioning

confidence: 99%

Twelve tips for teaching evidence-based physical examination

Mookherjee

Hunt

Chou³

2014

Medical Teacher

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Background: Practicing evidence-based physical examination (EBPE) requires clinicians to apply the diagnostic accuracy of PE findings in relation to a suspected disease. Though it is important to effectively teach EBPE, clinicians often find the topic challenging. Aims: There are few resources available to guide clinicians on strategies to teach EBPE. We seek to fill that need by presenting tips for effectively teaching EBPE in the clinical context. Methods: This report is based primarily on the authors' experience and is supported by the available literature. Results: We present 12 practical tips targeting the clinician educator. The first six tips condense key preparatory steps for the teacher, including basic statistics underpinning EBPE. The final six tips provide specific guidance on how to teach EBPE in the clinical environment. Conclusions: By practicing the 12 tips provided, clinicians will develop the confidence needed to effectively teach EBPE in inpatient or outpatient settings.

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Has Medicine Outgrown Physical Diagnosis?

Cited by 48 publications

References 6 publications

The third heart sound for diagnosis of acute heart failure

The third heart sound for diagnosis of acute heart failure

Effect of Bedside Physical Diagnosis Training on Third-Year Medical Students' Physical Exam Skills

Twelve tips for teaching evidence-based physical examination

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