Core bedside skills of history taking and physical examination--still vital to comprehensive assessment, diagnostic accuracy, and truly patient-focused care--are taught and assessed in the first two years of medical school but largely ignored once the student reaches the clinical years. During residency, development of these skills is assumed when in fact they wither further. The physical examination of newly admitted patients is often cursory and, what is worse, perverted by drop-down boxes into an exaggerated and invented form that reads better than the truth. Here, Elder et al share four principles to guide in enhancing residents' bedside skills and begin on the path back.
The bedside evaluation, consisting of the history and physical examination, was once the primary means of diagnosis and clinical monitoring. The recent explosion of imaging and laboratory testing has inverted the diagnostic paradigm. Physicians often bypass the bedside evaluation for immediate testing and therefore encounter an image of the patient before seeing the patient in the flesh. In addition to risking delayed or missed diagnosis of readily recognizable disease, physicians who forgo or circumvent the bedside evaluation risk the loss of an important ritual that can enhance the physician-patient relationship. Patients expect that some form of bedside evaluation will take place when they visit a physician. When physicians complete this evaluation in an expert manner, it can have a salutary effect. If done poorly or not at all, in contrast, it can undermine the physician-patient relationship. Studies suggest that the context, locale, and quality of the bedside evaluation are associated with neurobiological changes in the patient. Recognizing the importance of the bedside evaluation as a healing ritual and a powerful diagnostic tool when paired with judicious use of technology could be a stimulus for the recovery of an ebbing skill set among physicians.
There are good reasons to keep teaching students the art of examining the patient, and they are worth listing. First, there are many diagnoses that can and always will be readily be made by the physical exam.
A sweeping, emotionally riveting first novel—an enthralling family saga of Africa and America, doctors and patients, exile and home. Marion and Shiva Stone are twin brothers born of a secret union between a beautiful Indian nun and a brash British surgeon at a mission hospital in Addis Ababa. Orphaned by their mother’s death in childbirth and their father’s disappearance, bound together by a preternatural connection and a shared fascination with medicine, the twins come of age as Ethiopia hovers on the brink of revolution. Yet it will be love, not politics—their passion for the same woman—that will tear them apart and force Marion, fresh out of medical school, to flee his homeland. He makes his way to America, finding refuge in his work as an intern at an underfunded, overcrowded New York City hospital. When the past catches up to him—nearly destroying him—Marion must entrust his life to the two men he thought he trusted least in the world: the surgeon father who abandoned him and the brother who betrayed him. An unforgettable journey into one man’s remarkable life, and an epic story about the power, intimacy, and curious beauty of the work of healing others.
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