We had one of the local radiologists giving a lecture to the students on abdominal radiology and he made the point that clinical examination is dead; useless; irrelevant; a waste of time and energy.
You must admit he’s got something of a point there.
Now there’s an assumption here – that examination is poor and radiology is always sensitive and specific but I’m not going to go there now.
However most of our ‘classic’ signs of specific disease are dubious at best. Some are reasonable specific but often terribly sensitive. Some are reasonably sensitive but not terribly specific.
The obvious examples might be chest signs in pneumonia or classifying murmurs. In modern medicine most of these will result in a CXR or echo respectively that will determine management much more than the clinical signs will.
Now let be clear that I’m not saying clinical judgment is dead (though we seem to be trying our best to get rid of it…). Clinical judgement is the mysterious ‘gestalt’ that we get from talking to the patient, examining them (however limited the individual signs are) and making a judgment call. I think that’s one of our most valuable skills. I’m definitely not saying we need to do more tests in lieu of examination.
I have a few ideas of my own why examination and which bits still matter but for now I’d love to hear which bits of the examination you feel are really important. Which bits and components do you feel really change your clinical management or clinch the diagnosis? [Koplik’s spots aside…]