First do a careful history and physical


Category : Medical Rants

When the Simple Solution Is the Right One

One of the problems with diagnostic technology occurs when we forget the basics. I was taught many years ago that we can make 90% of diagnoses from the history and physical exam. I believe this is still true. Most times I have a great idea of the diagnosis (or at least have narrow the possibilities) after doing a careful history and targeted physical examination.

Each generation of physicians laments the lack of interest that younger physicians have in careful history and physical exams. As we mature in medicine we learn to value our clinical evaluations.

Insurers pay for technology handsomely. They pay meager amounts for careful exams. Now I am using hyperbole here, but I am correct in a relative manner.

This patient story about a runner with a sore foot dramatizes the problem. I love this story because it emphasizes an important teaching point. We should not spend money on tests unless they are likely to make a difference.

We spend too much money on unnecessary diagnostic tests. We do this because of malpractice fear. We do this because it is easier than taking the time for a history and physical exam.

I have countless stories about the history and physical making the diagnosis. Unfortunately, we are not paid for our careful cognition. We are paid by volume, and the history and physical take time. As I always say – time is money.

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Comments (2)

On eof my biggest problems with the push for us to see more patients is that in the rush to “move ’em through” we don’t allow ourselves enough time to cogitate. Especially now that we are on an EMR, so much of my focus is into gettint things types into the comupter to close out the visit.

[…] remember very clearly as a medical student hearing my attending hammer home the importance of the  history and physical examination.  Everyday I heard the same thing The history and physical examination is the most important part […]

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