The decline of our physical examination skills: is echocardiography to blame?

Abstract

It was a logical expectation that scientific progress and the availability of sophisticated imaging modalities over the last decades would have strengthened the effectiveness of the traditional physical exami-nation, which had not changed in almost 150 years. But, on the contrary, we witness a progressive decline in examination skills.1–7 Many colleagues bemoan this loss and blame our increasing reliance on imaging technologies and, more particularly, on echo-cardiography.3,4,6–8 However, the high quality of patient care of today has been the result from better diagnosis, and this has not been achieved by the traditional examination skills but by the application of imaging technologies. Therefore, rather than blaming echocardiography, there are many arguments why pocket-size ultrasound imagers should be used as an integral part of the physical examination at the point of care. Just like the introduction of the aural stethoscope initiated to the ‘golden era’ of clinical diagnosis, the incorporation of bedside ultrasound imaging will undoubtedly lead to a ‘new golden era’ of physical examination by providing a more accurate diagnosis, cost reduction by avoiding inappropriate tests, and a better patient–doctor rapport. Taking an accurate medical history followed by a physical examination including inspection, palpation, and indirect auscultation was the practice of Pharaonic doctors (G. Ebers Papyrus, ca. 1550 B.C.) Later, Hippocrates (5th century B.C.) and his disciples adapted these procedures for bedside examination and during the following two millennia medical practice remained essentially unchanged. By the 18th century, the physical examination was largely abandoned and medicine relied primarily on subjective opinion. Interest in the physical examination re-appeared after the pioneering work of G.B. Morgagni …