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Why the Physical Examination Gets No Respect

      To the Editor:
      Seasoned clinicians recognize the importance of the physical examination, yet many physicians, as Bergl et al
      • Bergl P.
      • Farnan J.M.
      • Chan E.
      Moving toward cost-effectiveness in physical examination.
      pointed out--particularly those who are still in training or are new to practice--seem to underestimate its value and place greater faith in imaging studies and blood tests.
      Most doctors would agree that the pressure to discharge patients as quickly as possible from hospitals has encouraged the overuse and indiscriminate use of testing of all sorts. The same applies to older doctors in private practice who are pushed by financial pressure to see as many patients as possible in a day, giving rise to the pejorative term “throughput.”
      Clearly, learning the skills of a good physical examination is critical to the education of young physicians. But in defense of those younger doctors who seem to indiscriminately order imaging and other tests rather than to make diagnoses that could be confidently and safely made by physical examination, it is important to mention that the threat of malpractice suits have seduced physicians into believing that the hard and objective findings of laboratory and radiologic studies will protect them more in defending malpractice suits than the softer and more subjective findings on physical examination.
      The point is that until the malpractice system becomes less adversarial and physicians feel less threatened by it, interest and respect for the physical examination will continue to decline.

      Reference

        • Bergl P.
        • Farnan J.M.
        • Chan E.
        Moving toward cost-effectiveness in physical examination.
        Am J Med. 2015; 128: 109-110

      Linked Article

      • Moving Toward Cost-effectiveness in Physical Examination
        The American Journal of MedicineVol. 128Issue 2
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          At present, 2 trends in teaching clinical medicine seem destined for harmonious marriage or perhaps mutually assured destruction: a renewed interest in physical examination and the push to provide high-value, cost-conscious care.
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      • The Reply
        The American Journal of MedicineVol. 128Issue 8
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          I appreciate Volpintesta's response to our article on moving toward cost-effectiveness in physical examination,1 and I wholeheartedly agree that throughput and efficiency often relegate physical examination to a mere ritual, particularly in inpatient settings. Indeed, diagnostic overuse likely has many causes, including patients' preferences for advanced testing, reimbursement models, and even fears of malpractice.
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