Bates' Physical Examination (2024)

There is a perception by the internal medicine community that physical examination skills have declined amongst both learners and teachers of medicine. A sense of lack of time and the development of more sensitive and specific diagnostic tests are amongst some of the reasons for this phenomenon. Internists need to be familiar with the clinical usefulness of physical examination maneuvers learned during medical school and residency training so that they know, at the bedside, what to focus on during the patient encounter. Here I would like to highlight some of these easy to perform physical examination signs that some data argues for and support their clinical utility in daily practice in the era of modern diagnostic technology. These are: the third heart sound; maximal tracheal height and Hoover's sign; the " HINTS " examination for patients with vertigo; and simple bedside questions to screen for delirium. There is a perception by the internal medicine community that physical examination skills, for many different reasons, have declined amongst both learners and teachers of medicine. Moreover, it is not an infrequent scenario for internists seeing patients in in-patient or outpatient setting to feel rushed at the bedside as they are trying to deliver high-value care for their patients. Many of the physical examination signs can be tested, just like any other diagnostic test, for their validity and power to rule in or rule out a disease. Internists need to be familiar with the clinical usefulness of physical examination maneuvers learned during medical school and residency training so that they know, at the bedside, what to focus on during the patient encounter. Here I would like to highlight some examples of bedside maneuvers which data support their utility at the bedside. They are also relatively simple to perform and thus can help when time constrain is an issue. They are: the third heart sound; maximal tracheal height and Hoover's sign; the " HINTS " examination for patients with vertigo; and simple bedside questions as part of the Elhassan M MedEdPublish Abstract Keywords: Physical Examination Skills, Likelihood ratio

AbstractBackground: Little is known about the quality of the physical examination and its effectiveness in daily practice. Objective:To determine if family physicians (FPs) were able to detect an important physical sign (hepatomegaly) and to relate thisresult with other measures of quality. Methods: 57 of 104 invited FPs from the National Health Service of the SouthernBarcelona Area agreed to schedule an unannounced Standardized Patient (SP) randomly into their daily practice. The SPpresented with hepatomegaly and mild abdominal pain. After the visit clinical notes, medical orders, an audiotape of thevisit and a checklist completed by the SP detailing items in the physical examination (PE) were analysed. The attainmentof a number of quality standards was assessed. Results: The three major findings that resulted from this study were: (a) only4 of the 57 FPs who examined the patient detected the hepatomegaly; (b) FPs performed better at history taking (84.24%)than at PE (26.35%); no correlation was found between the two; (c) diagnostic accuracy was associated with older age,years of experience, history taking skills and better performance at requesting diagnostic tests. Most FPs (88%) requestedthe appropriate tests. FPs who scored better on requesting diagnostic tests spent an average of four minutes more with thepatient. None of the participants detected the SP.Conclusions: Clinical hepatomegaly is difficult to detect, even by well trained FPs. Senior doctors scored better onphysical examination.Key words: Clinical skills, physical examination, professional competence, process assessment (health care), standardizedpatient

Journal of Internal Medicine, 2003

Practical Neurology, 2020

The patient history, 2012

An Evidence-Based Approach to Differential Diagnosis Edited By Mark Henderson, Lawrence Tierney and Gerald Smetana

European journal …

European Journal of Anaesthesiology 2003; 20: 612–618 © 2003 European Academy of Anaesthesiology ISSN 0265-0215 ... Role of history and physical examination in ... WA van Klei *,† , DE Grobbee † , CLG Rutten ‡ , PJ Hennis * , JTA Knape * , ... * University Medical Centre Utrecht, ...

Independent Medical Evaluation, 2018

British journal of nursing, 2006

BMJ (Clinical research ed.), 2005

The Scientific World JOURNAL, 2007

Sports Cardiology, 2021

The biopsychosocial model encompasses biological, social and psychological processes with the aim of offering a more holistic therapeutic approach. Good communication skills are vital for its application; they help to enhance the patient-physician relationship and can improve health outcomes. The clinical interview is a valuable diagnostic and therapeutic tool, but interviewing techniques are some of the most diffi cult skills to master and implement. The therapeutic alliance forged during the clinical encounter lays the foundations for ongoing patient care and education. The interview is usually the main source of information, but it is not the only one. Assessment scales, if used wisely, can strengthen the therapeutic alliance and promote treatment adherence. However, when psychological assessment tools are employed, care must be taken to avoid labelling patients with a mental health disorder. Professionals should avoid judgemental language and behaviour at all times.

Medical …, 2006

Introduction: History taking (HT) is the basis for medical practice. Although its format lacks a standard, many HT Instruments (HTI) were developed, applied, and automated throughout history. Objective: To build a history line about HTI development, its pros and cons. Method: We accessed medline and lilacs database through the bvs search engine, using HT equivalents in english, portuguese, french, spanish, and german. Original papers and reviews about HTI aiming general practice were selected, and their content comprehensively analyzed and discussed, following PRISMA guidelines. Results: From 24904 initial entries about HT since 1900, 105 were selected for analysis. First HTI was identified before the 1st World War, mainly as mental screening tools. Later, other general practices HTI were developed, integrating statistical and branching reasoning. Two advantages were consistently reported about clinician time saving and improvement on information gathering. However, their use did not become widespread, restricted to research scenarios and specific guidelines for clinical intervention. Conclusions: HTI benefits may result from ht systematization, and it is not clear if clinical time-saving results in economic and quality of care improvement. However, the systematization of HT and the use of computational processing power may help medical practice and should not be overlooked. Better comprehension of the diagnostic HT clinical act will help comprehend how HTI may be useful for clinical practice, reasoning and doctor patient relationship.

British Journal of General Practice, 2008

Introduction to Psychiatry, 2021