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Reengineering the Physical Examination for the New Millennium?

ARTICLE: Reengineering the Physical Examination for the New Millennium?

AUTHORS: William G. Nelson, Antony Rosen, Peter J. Pronovost

JOURNAL: JAMA2016;315(22):2391-2392. doi:10.1001/jama.2016.4470.

Most patients hope for more face-to-face time with their physicians. Most physicians want to ensure that (1) a diagnosis, treatment plan, and the expected benefits or adverse effects of treatment are well understood by the patient; (2) the patient is treated respectfully; and (3) the personal perspective of the patient is well understood by the physician. Similar to patients, particularly in the era of the electronic health record, physicians also desire a more meaningful interchange with their patients.

Many physicians are concerned that the bedside physical examination has been progressively deemphasized in favor of laboratory tests and imaging that are easy to obtain and record in electronic health records.1 Similarly, a recent systematic review suggested that the physical examination is of limited value.2 The traditional physical examination could benefit from significant revitalization and reengineering to make it more effective.

Most physicians start the physical examination with a general impression that begins during collection of the medical history. The intuition of an individual physician may dictate the pace of the physical examination if urgent intervention is required, or may orient the examination to address specific patient concerns. The physical examination remains the cornerstone of the patient evaluation. Failure to perform a physical examination, or incorrectly interpreting physical findings, may be a significant source of medical error, leading to missed or delayed diagnoses and incorrect or unnecessary treatments.3

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Kelsey Bennett