Re: a recent article in the Annals of Internal Medicine discussing the value of the bedside evaluation: November 3, 2011
The Annals of Internal Medicine
In an era that has fetishized imaging and laboratory testing, the authors’ espousal of the importance of the bedside evaluation has particular importance. (1) Even if one is not adept in the diagnostic skills that good bedside examination requires, there is much to be learned just by sitting down and talking to the patient and encouraging him/her to describe their symptoms and their personal histories. Talking and listening establishes a connection with patients that is a two-way affair. First, of course the doctors gets knowledge of when a symptom started, how long it has lasted, and any other accompanying information that along with the physical exam will help to establish a diagnosis. But, connecting with a patient also gives the doctor an added sense of respect for the patient that may encourage closer attention to the patient’s overall hospital and post-hospital care.
Today it is not unusual for patients to be discharged while still in the early stages of convalescence. Having diagnosed a patient’s pneumonia and started proper antibiotic therapy, it is too easy for a resident to rationalize that he/she has done everything necessary for the patient. Because hospitals are penalized for not discharging patients within prescribed time frames, there is a danger that they are conniving at premature discharging of patients and even proud their “through put” prowess.
Planting the seeds of “through-put” in the minds of residents can stifle their humanitarian instincts.
Thus residents should use the bedside evaluation not only for sharpening their clinical skills and for controlling the urge to resort to extensive imaging and laboratory testing, but also as a constant reminder of the intrinsically human character of medicine and the need to protect it.
1.Verghese A ,Brady E, Kapur C, Horwitz RI. The bedside evaluation: ritual and reason. Ann Int Med. 2011:155:553.