Physical Examination of the Liver

Naylor, C. David

doi:10.1001/jama.1994.03510470063036

Cited by 40 publications

(11 citation statements)

References 31 publications

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“…The low rates of interobserver agreement in radiology are not unique to radiology and are comparable to rates seen elsewhere in medical diagnosis 23–27 . In this regard, errors of interpretation in physical diagnosis and other medical diagnosis resemble errors of interpretation in diagnostic film reading.…”

Section: Perceptual Error In Diagnostic Radiologymentioning

confidence: 91%

Perceptual error and the culture of open disclosure in Australian radiology

Pitman

2006

Australasian Radiology

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The work of diagnostic radiology consists of the complete detection of all abnormalities in an imaging examination and their accurate diagnosis. Errors in diagnostic radiology comprise perceptual errors, which are a failure of detection, and interpretation errors, which are errors of diagnosis. Perceptual errors are subject to rules of human perception and can be expected in a proportion of observations by any human observer including a trained professional under ideal conditions. Current legal standards of medical negligence make no allowance for perceptual errors, comparing human performance to an ideal standard. Diagnostic radiology in Australia has a culture of open disclosure, where full unbiased evidence from an examination is provided to the patient together with the report. This practice benefits the public by allowing genuine differences of opinion and also by allowing a second chance of correct diagnosis in cases of perceptual error. The culture of open disclosure, which is unique to diagnostic radiology, places radiologists at distinct medicolegal disadvantage compared with other specialties. (i) Perceptual error should be acknowledged as an integral inevitable part of diagnostic radiology; (ii) culture of open disclosure should be encouraged by the profession; and (iii) a pragmatic definition of medical negligence should reflect the imperfect performance of human observers.

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Section: Perceptual Error In Diagnostic Radiologymentioning

confidence: 91%

Perceptual error and the culture of open disclosure in Australian radiology

Pitman

2006

Australasian Radiology

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“…Regarding which specific physical examination skills should be emphasized, JAMA has published an ongoing series of critical reviews entitled the "Rational Clinical Examination," [8][9][10][11][12][13][14][15][16][17][18][19] and this information can help guide the selection of specific skills that deserve emphasis. To identify those specific skills which should be targeted for improvement in instruction, we should know the skills in which physicians, residents, and medical students are least confident in their ability, as well as those skills that they view as being most important.…”

Section: Introductionmentioning

confidence: 99%

Self-Confidence in and Perceived Utility of the Physical Examination: A Comparison of Medical Students, Residents, and Faculty Internists

Fagan

Reinert

et al. 2007

J GEN INTERN MED

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BACKGROUND AND OBJECTIVES:Little is known about the differences in attitudes of medical students, Internal Medicine residents, and faculty Internists toward the physical examination. We sought to investigate these groups' self-confidence in and perceived utility of physical examination skills. DESIGN AND PARTICIPANTS:Cross-sectional survey of third-and fourth-year medical students, Internal Medicine residents, and faculty Internists at an academic teaching hospital. MEASUREMENTS:Using a 5-point Likert-type scale, respondents indicated their self-confidence in overall physical examination skill, as well as their ability to perform 14 individual skills, and how useful they felt the overall physical examination, and each skill, to be for yielding clinically important information. RESULTS:The response rate was 80% (302/376). The skills with overall mean self-confidence ratings less than "neutral" were interpreting a diastolic murmur (2.9), detecting a thyroid nodule (2.8), and the nondilated fundoscopic examination using an ophthalmoscope to assess retinal vasculature (2.5). No skills had a mean utility rating less than neutral. The skills with the greatest numerical differences between mean self-confidence and perceived utility were distinguishing between a mole and melanoma (1.5), detecting a thyroid nodule (1.4), and interpreting a diastolic murmur (1.3). Regarding overall self-confidence, third-year students' ratings (3.3) were similar to those of first-year residents (3.4; p=.95) but less than those of fourth-year students (3.8; p=.002), upper-level residents (3.7; p=.01), and faculty Internists (3.9; p<.001).CONCLUSIONS: Self-confidence in the physical exam does not necessarily increase at each stage of training. The differences found between self-confidence and perceived utility for a number of skills suggest important areas for educational interventions.

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“…This may be because most patients are righthanded and, therefore, have a larger muscle mass in the right arm that is less easily compressed by the blood pres-120(38. 7) 36(11.6) 64 (20.6) 12 (3.9) 159(51. 3) 46 (14.8) sure cuff.…”

Section: Discussionmentioning

confidence: 99%