Two extremes of modern medicine are:
Physical exam is so outdated -- we have all kinds of technological advances now!
and
H&P solves 90% of cases! All this other stuff is mostly just ancillary.
Thread...
1/
Physical exam is so outdated -- we have all kinds of technological advances now!
and
H&P solves 90% of cases! All this other stuff is mostly just ancillary.
Thread...
1/
I find both of these positions problematic.
The key is to know what tools to use in which circumstances.
2/
The key is to know what tools to use in which circumstances.
2/
If a patient with AML and long-standing neutropenia has a fever and cough for 3 days --> we need a CT-chest. No amount of physical exam or extra history taking is going to replace that.
3/
3/
Conversely, if a young patient comes with unexplained syncopal episodes, a thorough history, cardiac exam, and EKG will be critical. Labs are probably going to be unrevealing.
4/
4/
Additionally, a patient can have a life-threatening illness (e.g., STEMI) but have normal vital signs, physical exam, and labs.
5/
5/
Conversely, simply because a patient is asymptomatic with a normal exam, it does not mean we can or should ignore unexplained lab abnormalities (e.g., K of 6.5 or Ca of 13 or hemoglobin of 9.5).
6/
6/
The best clinicians I know use all relevant pieces of data in the right clinical situations.
7/
7/
They know when history is key, which physical exam components and maneuvers will help in certain scenarios, and how to thoughtfully incorporate labs + imaging into their clinical reasoning.
8/
8/
Ignoring certain components of patient data or overemphasizing only history and physical exam or only labs + imaging is how diagnoses and clues are missed.
9/
9/
So, in conclusion:
- Use all pt data (history, PE, labs/imaging) thoughtfully and carefully.
- Utilize the right information in the correct situations.
- Don't ignore lab or imaging abnormalities only b/c the pt is Asx (must learn in which situations to pursue further).
Fin/
- Use all pt data (history, PE, labs/imaging) thoughtfully and carefully.
- Utilize the right information in the correct situations.
- Don't ignore lab or imaging abnormalities only b/c the pt is Asx (must learn in which situations to pursue further).
Fin/
Would love your thoughts on this!
@buckeye_sanjay @SatyaPatelMD @DxRxEdu @rabihmgeha @divya_kondapi @DrRossanaRosa @KelleyChuangMD @HollandKaplan
@buckeye_sanjay @SatyaPatelMD @DxRxEdu @rabihmgeha @divya_kondapi @DrRossanaRosa @KelleyChuangMD @HollandKaplan
.@InchausteguiC @CNemehMD -- would love your thoughts as well!
.@adamcifu @AdamRodmanMD -- would love your thoughts on this thread as well!
جاري تحميل الاقتراحات...