farmdoc's blog post number 687

The saying ‘use it or lose it’ is entrenched in our lexicon [1]. Though it’s broadly applicable, today I write of it in the context of medical practice. But there’s an even scarier medical scenario than poor results due to atrophied skills. And that’s when the skills haven’t been acquired in the first place. Which apparently is so regarding the physical examination part of the medical process (the other two parts are the history/interview, and special tests such as blood tests, x-rays and scans). I’ve written before about the importance of the physical examination [2, 3]. I recently read a book titled Every Patient Tells a Story – which both emphasises that importance, and laments that US medical students and recent graduates lack the ability to perform a thorough and accurate physical examination. Now the MJA’s Editor has weighed in – via this piece in the 1 March 2010 issue. He cites the ‘Stanford 25’ – ‘…25 technique-dependent manoeuvres that are now mandatory for (Stanford) trainees to learn’. And he exults in his observation that the physical examination skills of Australian doctors greatly exceed those of our US colleagues. The sorry state of US doctors’ physical examination skills means they rely more on special tests which can be expensive, so driving up US healthcare costs. The crunch time for US healthcare reform legislation approaches [4]. If it becomes law, cost caps may force US doctors to improve their physical examination skills. Ho hum.