Utility of Clinical Examination in the Diagnosis of Emergency Department Patients Admitted to the Department of Medicine of an Academic Hospital

Paley, Liza; Zornitzki, Taiba; Cohen, Joel W.; Friedman, Joshua B.; Козак, Н. В.; Schattner, Ami

doi:10.1001/archinternmed.2011.340

Cited by 88 publications

(53 citation statements)

References 8 publications

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“…We are faced with the following question, "Should educators abandon the teaching of palpation in the health science curriculum where technology, such as ultrasound is readily available?" Paley et al, [40] a group of emergency physicians, argued that the increased use of ultrasound due to advances in technology can be costly and may compromise a patients' quality of care because if clinicians can do good assessment not everyone will require an ultrasound. Thus, we are proposing to bring head and neck palpation teaching back not only to nursing but other disciplines.…”

Section: Discussionmentioning

confidence: 99%

The practice and teaching of palpation of the head and neck: A scoping review

Epstein

Herne²,

Masita³

et al. 2017

JNEP

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Objective: To explore how palpation of the head and neck is practiced and taught. Methods: The scoping review methodology was guided by Arksey and O'Malley's five-stage approach. Three experienced and independent reviewers searched nine databases according to a predetermine inclusion and exclusion criteria. Results: A total of 15 articles from medicine, chiropractic and dentistry published between 1987 and 2016 were included. Two overarching themes emerged, a Cartesian and a Pragmatic perspective in practicing and teaching palpating of the head and neck. Although both perspectives are valuable, we advocate to practice and teach palpation of head and neck from a Pragmatic perspective particularly with the increase use of ultrasound technology to detect masses. A pragmatic perspective takes into account the patient's context, the ethics of care and highlights the importance of health care providers fostering interpersonal relationships with others during physical assessment. Conclusions: Although nursing studies were absent from this review we believe nurses play a vital role when they are aware of the Cartesian and Pragmatics perspectives when practicing and teaching head and neck palpation as part of a physical assessment. Learning how other disciplines are practicing and teaching head and neck palpation skills will improve interdisciplinary collaboration.

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Section: Discussionmentioning

confidence: 99%

The practice and teaching of palpation of the head and neck: A scoping review

Epstein

Herne²,

Masita³

et al. 2017

JNEP

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“…In a study looking at >400 consecutive patients admitted to an emergency department, it was the history and physical examination together that proved to be the most accurate modality in making the correct diagnosis; a diagnosis was accurately made by history and physical examination in ≈60% of the cases. 21 Another study observed that a pivotal physical examination finding by an experienced clinician led to a substantial change in a patient's treatment course in 25% of cases. 22 Indeed, it is not the testing that makes a diagnosis, it is the physician who uses these tools as guided by his/her evaluation of the patient.…”

Section: Discussionmentioning

confidence: 99%

The Thrill Is Gone

2015

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Foreword Information about a real patient is presented in stages (boldface type) to expert clinicians (Drs Beckman and Sobieszczyk), who respond to the information, sharing his reasoning with the reader (regular type). A discussion by the authors follows.A n 85-year-old white woman with longstanding atrial fibrillation and hypertension presented to our emergency department with a 2-day history of progressive dyspnea. Earlier that week she had been seen by an outpatient provider and was found to be hypotensive. Her home bumetanide was discontinued, and she developed dyspnea that progressed after missing 2 doses. She reported that she was sleeping with more pillows and that she had a limited ability to walk and a new cough.Her recent history was notable for progressive fatigue and dyspnea over the past year. In the past 3 months she had been treated as an outpatient with loop diuretics for presumed congestive heart failure by a cardiologist. Her recent history was also notable for recurrent hematochezia requiring 5 admissions, including an intensive care unit admission for hemorrhagic shock, over the preceding 6 months. An extensive evaluation, including esophagastroduodenoscopy, several colonoscopies, and a small-intestine capsule study were unrevealing; she was noted only to have severe diverticulosis. During this period, her warfarin and, after additional bleeding episodes, her aspirin were stopped in light of her recurrent bleeding.Additional medical history included a diagnosis of cataracts, macular degeneration, and osteoarthritis. Medications included bumetanide 1 mg daily, metoprolol succinate 50 mg daily, omeprazole 40 mg daily, and calcium supplements. She had no known drug allergies.Dr Beckman: Dyspnea in an older patient is a common concern and is predominantly caused by a range of cardiopulmonary diseases. In this case, the patient's presentation is notable for progressive dyspnea over 1 year that has acutely worsened over several days. Her report of orthopnea, cough, and exertional intolerance suggest that an exacerbation of congestive heart failure is likely. Moreover, her diagnosis of congestive heart failure is only presumed, and further investigation is needed to understand this acute presentation. Other etiologies of progressive dyspnea include anemia related to her recent gastrointestinal bleeding, or a primary pulmonary process such as interstitial lung disease, chronic obstructive pulmonary disease, malignancy, pulmonary hypertension, or an infectious process such as a viral respiratory infection or pneumonia. Patient presentation (continued):Initial vital signs on presentation included an oral temperature of 95°F, a heart rate of 81 beats per minute, blood pressure of 110/56 mm Hg, respiratory rate of 20 breaths per minute, oxygen saturation of 85% on room air with improvement to 95% on 3 L nasal cannula oxygen supplementation. Physical examination was notable for a cachectic-appearing woman in no acute distress. Her neck examination revealed marked internal jugular venous engorgement with v...

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“…1,2 The perception that physical examination has limited value has developed despite the substantial literature demonstrating that many of its components possess diagnostic utility, 3,4 that it still contributes to diagnosis, 5 and that poorly performed or completely omitted physical examination contributes to clinical errors. 6 It is also argued, perhaps most importantly, that Amid this uncertainty, there is little published information describing clinicians' opinions about the value of physical examination in contemporary clinical practice.…”

Section: Introductionmentioning

confidence: 99%

The value of the physical examination in clinical practice: an international survey

Elder¹,

McManus

Patrick

et al. 2017

Clinical Medicine

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A structured online survey was used to establish the views of 2,684 practising clinicians of all ages in multiple countries about the value of the physical examination in the contemporary practice of internal medicine. 70% felt that physical examination was 'almost always valuable' in acute general medical referrals. 66% of trainees felt that they were never observed by a consultant when undertaking physical examination and 31% that consultants never demonstrated their use of the physical examination to them. Auscultation for pulmonary wheezes and crackles were the two signs most likely to be rated as frequently used and useful, with the character of the jugular venous waveform most likely to be rated as infrequently used and not useful. Physicians in contemporary hospital general medical practice continue to value the contribution of the physical examination to assessment of outpatients and inpatients, but, in the opinion of trainees, teaching and demonstration could be improved. KEYWORDS :Bedside medicine , medical education , physical examination , physical signs IntroductionOver the past 30 years, increasing use of technology has cast doubt on the value of physical examination in contemporary patient care. 1,2The perception that physical examination has limited value has developed despite the substantial literature demonstrating that many of its components possess diagnostic utility, 3,4 that it still contributes to diagnosis, 5 and that poorly performed or completely omitted physical examination contributes to clinical errors.6 It is also argued, perhaps most importantly, that ABSTRACTThe value of the physical examination in clinical practice: an international survey the act of physically examining a patient sits at the very heart of the clinical encounter and is vital in establishing a healthy therapeutic relationship with patients. 7 Critics of the physical examination cite its variable reproducibility and the utility of more sensitive bedside tools, such as point of care ultrasound, in place of traditional methods. 2,8

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Utility of Clinical Examination in the Diagnosis of Emergency Department Patients Admitted to the Department of Medicine of an Academic Hospital

Cited by 88 publications

References 8 publications

The practice and teaching of palpation of the head and neck: A scoping review

The practice and teaching of palpation of the head and neck: A scoping review

The Thrill Is Gone

The value of the physical examination in clinical practice: an international survey

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