Why We Can’t Allow Physical Exam Skills to Languish
SOURCE: Verghese A, et al. Inadequacies of physical examination as a cause of medical errors and adverse events: A collection of vignettes. Am J Med 2015;128:1322-1324.
With more highly evolved and readily available technology at our fingertips, it is sometimes tempting to let the echocardiogram sort out the abnormal heart sounds we detected, or allow the pelvic ultrasound to inform whether the uterus is enlarged, or short-cut parts of the physical exam we anticipate to be unlikely sources of pertinent information. At the same time, there may not be large-scale clinician awareness that a textbook of Evidence-based Physical Diagnosis even exists. (McGee, S. Evidence-based Physical Diagnosis, 3rd Edition. Philadelphia: Elsevier Saunders Publishers; 2012.) Could over-reliance on technology lead to meaningful errors?
Verghese et al reported on 208 vignettes that were volitionally reported to them in response to a survey soliciting instances of oversights related to the physical exam. The most common consequence of an inadequate physical exam was missed/delayed diagnosis. However, unnecessary treatment, delay in treatment, unnecessary exposure to radiation or contrast, and complications related to treatment were also reported.
Commonly missed items included abdominal masses, pregnancy, neurologic findings, murmurs, adenopathy, breast masses, heart failure, and herpes zoster. The authors reported that most of the cases in which inadequate physical examination led to consequences were the result of simply not performing the appropriate physical exam (rather than, for example, misinterpretation of an appropriately performed exam).
The authors made a case for reminding clinicians that appropriate physical examination skills need to be taught and maintained. Inadequate performance of the physical exam, as documented here, can lead to important consequences.
Inadequate performance of the physical exam can lead to important consequences.
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