How do you see this article developing? For example, one direction is the art and science of physical diagnosis. Another is the role of periodic physical examination in health maintenance. Another is the classic balance of history vs. physical ("Treat the patient, not the chart, Doctor. The chart isn't sick.") and which should be done first, and now the balance of H&P vs. diagnostic tests (i.e., is this pathology or a Victim Of Modern Imaging Technology?)
Howard C. Berkowitz 18:15, 18 May 2008 (CDT)
O/E, O/I, O/P, O/A
I'd like to see the terms 'On Examination', 'On Inspection', 'On Palpation', 'On Percussion' and 'On Auscultation' here.—Ramanand Jhingade 03:38, 16 October 2008 (UTC)
- Seriously, why? This is an encyclopedia, not a dictionary of abbreviations.
- Next, they are not customary in the medical literature. If rales or ejection murmurs are noted in the record of examination, it is assumed the reader knows that these are from auscultation. If there were electronic assistance, that would be noted.
- One may write that the inferior edge of the liver is palpable, but the custom is to write the finding; the means of examination is assumed from context. In like manner, a maculopapular rash or a Romberg sign is inherently observed. Howard C. Berkowitz 03:50, 16 October 2008 (UTC)
- I don't need answers.com when, say, I have Bates' Guide, Principles and Practice of Medicine (originally Osler's), and half a dozen other texts -- plus doing decision support for physical exam and history since 1970. Answers.com is not authoritative. Howard C. Berkowitz 03:38, 18 October 2008 (UTC)
Can we tighten the wording?
- Can para 1 be moved to precede 'Components of the physical examination' (since it is not really part of the exam) and shortened to something like:
- Usually, the first step is to solicit the patient's chief complaint and medical history in order to focus the subsequent examination.
- Is the section, 'Evolution in mainstream medicine', needed? If you want to keep it, how about keep only the paragraph with 'treat the patient, not the chart' and move a shortened version to the introduction of the article. Ok if I have a try at moving this paragraph and deleting the rest of 'Evolution in mainstream medicine'?
Thanks - Robert Badgett 14:08, 6 February 2009 (UTC)
Is acupuncture a diagnostic method? I thought it was strictly therapeutic? - Robert Badgett 14:12, 6 February 2009 (UTC)
- Needs correction. The physical examination in traditional acupuncture, which certainly can be a link, has components not used in Western medicine. A major area is what is loosely called "pulse taking", but, in some cases, that's a question of degree and detail than absolute technique. In a regular Western physical, one often takes the pulse and blood pressure on one extremity, with a seated patient. Most cardiologists will, on a first visit, take it on all extremities, standing, sitting, and supine. Most primary care physicians glance at the skin while a dermatologist may do a full examination, with magnification and perhaps Wood's Light illumination. Howard C. Berkowitz 14:51, 6 February 2009 (UTC)
- Acupuncture has a diagnostic method to arrive at a treatment protocol. See this as an example. Most is through observation and palpation, i.e. physical examination. Western users are much less likely to use the traditional diagnostic methods, but if you look at them closely, they are just physical exam findings, really nothing we don't use, but perhaps taken to a different level. D. Matt Innis 15:38, 14 February 2009 (UTC)
Approaches versus methods
Ok that I reorganized in order to distinguish approaches versus methods? - Robert Badgett 14:15, 6 February 2009 (UTC)
Evolution in mainstream medicine
I am not seeing what the first two paragraphs in this section contribute here. Can these be removed and the section be relabeled 'Underutilization of the physical examination' for the remaining paragraph? - Robert Badgett 07:33, 14 February 2009 (UTC)
- I think the concept of those two paragraphs adds some value to the article in the form of illustrating that the physical examination has been transformed by innovation and modern technology in modern medical evaluation, which is certainly an interesting topic. It then seems to want to say that these technical innovations have led examination away from the physical examination and history taking - which is the paragraph that you want to save. It sure seems like these two concepts can be made to work together, although a sectional title change might be appropriate. D. Matt Innis 16:08, 14 February 2009 (UTC)
- Maybe we could combine paras 1 and 2 of this section and rewrite more succinctly based on how you explained it above. Something simple like the technologies of the stethoscope, ophthalmoscope, etc have greatly helped the examination. Then, the second para (currently para 3) is the one about over-reliance on tests. - Robert Badgett 22:53, 14 February 2009 (UTC)
- Sounds perfect. Then toward the end it would be appropriate to mention the part about how physicians still use the physical exam with all the refs you added as I do think they are moving more in that general direction again, especially with the advent of cost efficiency. D. Matt Innis 00:02, 15 February 2009 (UTC)
- The Ottawa ankle rules perhaps should be linked here, with text explaining the reason why they are cost-effective. Since an X-ray helps management only if there is a fracture, restricting the X-rays to the fracture subset is the real goal. Previously, however, it was necessary to X-ray to decide if there was a fracture. Howard C. Berkowitz 00:48, 15 February 2009 (UTC)