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Bedside Physical Examination Is Not Obsolete

Published:January 05, 2015DOI:https://doi.org/10.1016/j.amjcard.2014.12.028
      I read the study by Silverman and Gertz.
      • Silverman B.
      • Gertz A.
      Present role of the precordial examination in patient care.
      Contrary to what is implied by the authors in their discussion, I am a vocal proponent of the clinical examination—as my patients, colleagues, and trainees will attest. Indeed, I was wounded by their implication that I do not believe cardiac physical examination plays an essential role in patient care. If the authors had more thoroughly discussed my article,
      • Phoon C.K.
      Must doctors still examine patients?.
      they would have recognized the comments they cited represented a “protagonist” view; my conclusions however were that the “antagonist” view—that is, the physical examination will continue to be an important and central part of patient care—will continue to rule for the foreseeable future. Moreover, although I agree there is a paucity of studies on the accuracy of bedside examination, I have contributed to the literature on honing the cardiac physical examination,
      • Phoon C.K.
      Estimation of pressure gradients by auscultation: an innovative and accurate physical examination technique.
      • Phoon C.K.L.
      A Guide to Pediatric Cardiovascular Examination or, How to Survive an Outreach Clinic.
      • Phoon C.K.L.
      Continual practice with echocardiography improves clinical estimation of pressure gradients.
      a fact the authors have overlooked.
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      References

        • Silverman B.
        • Gertz A.
        Present role of the precordial examination in patient care.
        Am J Cardiol. 2015; 115: 253-255
        • Phoon C.K.
        Must doctors still examine patients?.
        Perspect Biol Med. 2000; 43: 548-561
        • Phoon C.K.
        Estimation of pressure gradients by auscultation: an innovative and accurate physical examination technique.
        Am Heart J. 2001; 141: 500-506
        • Phoon C.K.L.
        A Guide to Pediatric Cardiovascular Examination or, How to Survive an Outreach Clinic.
        Lippincott-Raven, Philadelphia, PA1998
        • Phoon C.K.L.
        Continual practice with echocardiography improves clinical estimation of pressure gradients.
        J Am Soc Echocardiogr. 2011; 24 ([abstract, presented at the American Society of Echocardiography Annual Scientific Sessions, June 13, 2011, Montreal, Quebec, Canada]): B49

      Linked Article

      • Present Role of the Precordial Examination in Patient Care
        American Journal of CardiologyVol. 115Issue 2
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          Recent observations suggest that many physicians do not consider the bedside cardiac examination as a valuable tool in patient care. Internists, hospitalists, emergency department physicians, cardiologists, physician assistants, and nurse practitioners were interviewed to ascertain their current practice in completing the cardiac examination. In addition, we surveyed patients in a cardiology practice concerning their attitudes about the cardiac physical examination. The study found that a significant number of practitioners failed to carry out a basic cardiac examination.
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