No previously published studies have addressed the clinical importance of physical examination in the care of patients in hospital. Brendan Reilly from Cook County Hospital, Chicago, USA, did physical examinations on 100 patients who had been admitted to the hospital's general medical service in the previous 24 hours, all patients having had initial diagnosis made by other physicians.
Around a quarter of 100 patients examined had pivotal physical findings-those whose diagnosis and treatment in hospital changed substantially as a result of the senior physician's bedside physical examination. Over half of these pivotal physical findings were validated by a consulting specialist.
Brendan Reilly comments: "These results show that physical examination can have a substantial effect on the care of medical inpatients. About one in every four (26%) patients in the present investigation had pivotal physical findings. In many patients, these findings prompted active collaboration by specialist consultants to perform urgent surgical (or other invasive) procedures. These findings have important implications for medical education and efforts to improve the safety and quality of hospital care." (last sentence of quote does not appear in published paper).
Lancet 2003; 362: 1100-05
Contact: Dr Brendan Reilly, Department of Medicine, Cook County Hospital, Room 2129, 1901 W Harrison Street, Chicago, IL 60612, USA;
T) 312-864-7200;
F) 312-864-9725;
E) breilly@cchil.org
The Lancet