The Physical Exam--Diagnostic or Anachronistic

With the advance of higher resolution of organ imaging and diagnostic molecular biology, it is reasonable to assess the remaining value of the physical examination in medical practice. Among interactions with patients, a careful history is most important and results in diagnosis at least 70% of the time. Physical examination, imaging, and laboratory studies contribute another 15% and a combination of these accounts for the remainder. It is assumed that technological tests are more objective and reliable than the physical exam, but some authorities suggest that the reliability of a well-done physical exam rivals both imaging and laboratory results including histopathologic findings. The flagging performance of physical diagnosis by trainees may be related to lack of expertise by academic faculty. However, despite the hectic pace of medicine today, a conscientious physician should feel obligated to examine the culprit organ system suggested by the history in a “world-class,” textbook fashion at the very least. Occasionally such attention to detail will often confirm the history and could at times lead to unexpected findings which re-direct the workup. Even negative findings may have value in reassuring both patient and doctor. The common abbreviation “WNL” should never stand for “We never looked” for a caring physician who is genuinely interested in their well-being.