In medicine skills are almost like a status symbol. Whether your colleagues will speak highly of you greatly depends on whether you are able to perform angiograms, ultrasound or other procedures.
But there is one skill that you don’t get much credit for, even though it is indispensable:
Ask ten fourth-year-students, what they rather want: a lesson of lung auscultation or to visit the cath lab? More than likely nine of them will choose the cath lab.
Let’s say you have a patient with dyspnea, who is admitted to the ICU. Many times before a thorough physical exam unexperienced doctors will suggest
- a CT scan to exclude pulmonary embolism or even
- intubation.
“Look at the patient! She is so sick! We haven’t got time for a physical!“ In that case, I reply: “We don’t have time NOT to examine her before further workup.”
With more and more available diagnostic measures we tend to lose our focus on the most important skill in medicine.
Physical examination together with history taking has always been and always will be the task that’ll distinguish a good doctor from a bad doctor. Here are four reasons, why it will always be indispensable:
A thorough exam will deliver abundant pieces of information that are
1. Valuable:
- Pulmonary edema,
- Pleural effusion
- Pneumothorax
- Asthma attack
- (and many times but not always) Pneumonia.
And none of the diagnosis above generally require a CT scan.
2. Risk-free
I don’t know of any patient who was harmed by a quick and focused physical examination.
3. Rapidly available
You don’t have to wait for the results. No radiologic exam, lab test, will deliver faster results.
4. Absolutely FREE.
Costs of work-up are an important factor.
