Is cardiorespiratory examination useless?
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Cardiology
Is cardiorespiratory examination useless?
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Des Spence has written a piece in the BMJ this week about the usefulness (or actually uselessness) of chest examination. Now I fully acknowledge that I am attached to my echo probe but I don't agree.
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Forums » Open clinical » Cardiology » Is cardiorespiratory examination useless?
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Is cardiorespiratory examination useless?
posted at 8/7/2012 11:02 AM BST
on bmj.com
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Posts: 897
First: 17/6/2011 Last: 17/6/2013 |
Des Spence has written a piece in the BMJ this week about the usefulness (or actually uselessness) of chest examination. Now I fully acknowledge that I am attached to my echo probe but I don't agree. I acknowledge that clinical assessment is history and examination but one doesn't happen without the other plus the alternative is just lots more tests and surely that is worse medicine? http://www.bmj.com/content/345/bmj.e4569 |
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Re: Is cardiorespiratory examination useless?
posted at 8/7/2012 11:42 AM BST
on bmj.com
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Posts: 51
First: 2/8/2010 Last: 8/7/2012 |
I'm a medical student and I've never pretended I'd heard something if I hadn't and I admitted hearing something when my tutor hadn't. I find physical examination still very useful, after a good history is taken. It's not sensible and not specific but initial signs of disease can be present in totally asymptomatic patients. I would also add the improtance of clinical signs for follow-up. Almost everything will need to be confirmed by more advanced tests but I can still see a role for my ears and eyes... Maybe I'll change my mind in the future... |
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Re: Is cardiorespiratory examination useless?
posted at 8/7/2012 3:45 PM BST
on bmj.com
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Posts: 3059
First: 27/3/2012 Last: 13/6/2013 |
I agree. A good clinical history & clinical examination are the most important aspects of any patient's assessment. The other investigations should then be specific & minimal accordingly. |
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Re: Is cardiorespiratory examination useless?
posted at 8/7/2012 4:00 PM BST
on bmj.com
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Posts: 627
First: 13/4/2011 Last: 18/6/2013 |
I have also read this article. And I disagree with the author. History taking and good physical examination are the first step in cardiorespiratory exams. By the way, the pulmonary sounds and the basic heart sound are not that difficult to learn and not that easy to forget once learned. All Best, Joey
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Re: Is cardiorespiratory examination useless?
posted at 8/7/2012 5:01 PM BST
on bmj.com
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Posts: 1302
First: 9/12/2011 Last: 12/6/2013 |
No, it is very helpful. Simple rales, wheezing, bronchitis, Pneumonia, can be determined with stethescope, as well as myriad caridiac problems, to include various cardiac murmurs, etc. Sometimes a simple test is elegant. DuaneF |
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Re: Is cardiorespiratory examination useless?
posted at 8/7/2012 7:47 PM BST
on bmj.com
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Posts: 347
First: 17/12/2011 Last: 18/6/2013 |
No it can be informative. I agree with Dr Spence that in many cases the use may be related to the 'laying on of hands' . I agree that usually 80% of the diagnosis comes from the history , but examination is still useful and can be diagnostic. I can think of a lady I saw last week who complained of increasing shortness of breath ,she was under oncologist and her last recent check was, ok , examination showed a right sided pleural effusion . It is true I asked for an Xray after examining her , but examination helped me explain to the patient what was wrong and why she was SOB. May be I am biased because my first pre registration house job was under an excellent Chest Physician Dr Ellis at Ham Green Hospital in Bristol. I think I feel the pulse in almost all my patients, one can learn a great deal from a pulse, i check most of my adult patients BPs, I weigh many of my patients and it only takes say 2 minutes to examine a patients hands and chest in general practice I also lie down and examine patient with abdominal symptoms. The number of times treatment or a diagnosis is changed may be fairly low. Atrial fibrillation and slow and fast pulses should be recorded, and temperature of febrile patients recorded. Heart murmurs can be useful and the presence or absence of murmurs may help diagnosis and influence a decision to refer or not to refer for secondary care. Examination is low tech, but it may be therapeutic and I think is good medicine . i think it is good to touch your patients , although this probably gets us back to hand washing! I think examination is part of the art of medicine and long may it continue. It some times seem that the bureaucrats would like all medical examination and treatment to be a series of tic boxes and pathways and protocols. Long live the Art. Sorry for any typos, no spell checker on ipad. |
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Re: Is cardiorespiratory examination useless?
posted at 8/7/2012 9:43 PM BST
on bmj.com
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Posts: 1828
First: 7/3/2009 Last: 18/6/2013 |
I strongly disagree with the article.Of course it is important. The amount of findings that I have encountered over the years is wast. Among them serious cardiac anomalies, asthma, pneumonia, COPD, atelectases, bronchiectases,etc. etc. |
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Re: Is cardiorespiratory examination useless?
posted at 8/7/2012 11:18 PM BST
on bmj.com
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Posts: 2139
First: 12/3/2010 Last: 19/6/2013 |
I shall copy this article to our POA nurses. They are good at detecting murmurs, untrained (and not wanting the diagnostic role - they are nurses) yet are as good as me, who can tell an aortic from a mitral, but that's about it. We all rely today on the echo, thanks to sadian and his ilk, and it's good not to be seen as better than you are. John |
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Re: Is cardiorespiratory examination useless?
posted at 9/7/2012 9:07 AM BST
on bmj.com
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Posts: 1828
First: 7/3/2009 Last: 18/6/2013 |
In oder to get to echo in a screening of a population you examine and listen to the heart sounds.When you detect a murmur, a click, snap, S3, S4, pericardial rub,distant heart sounds etc you refer to a cardiologist and then he can perform/send to echo. You just can't do echo for the whole population.There are not enough echo's and technicians/cardiologists and nobody will finance it. Being involved in screening, I can't imagine sending all to echo.On the other hand, I can't dismiss findings that need further examination. When dealing with a patient in hospital it is different and yes, you can do echo to all. However, I think there are enough situations that our old friend the stetoscope can help us. When something develops or suddenly happens you first rely on your senses and that includes your ears. A patient in dyspnea can be with pneumonia,pneumothorax,pulmonary oedema, athma, pulmonary embolus, etc etc. An auscultation to heart can reveal all I mentiond above and still more.. Let us not bury our clinical expertise so soon. |
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Re: Is cardiorespiratory examination useless?
posted at 9/7/2012 1:30 PM BST
on bmj.com
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Posts: 2139
First: 12/3/2010 Last: 19/6/2013 |
Yoram, sadian, Our cardiologist says, he spends his time training doctors to diagnose heart sounds, it takes six years. He's not about to train anaesthetists or POA nurses in one lecture and a demonstration. Nor does he want (and why should he?) see the dozens of pats. whose murmurs are picked up by POA, and occasionally an anaesthetist. Echoes are the answer, with referral to him if they seem to a non-cardiologist to be significant, or if we want his advice. So we're NOT sending all to echo. We're screening them, with view to anaesthesia and surgery, selecting those who have a murmur (or occasionally other symptoms or signs), screening those by echo and then referring those who need a cardiology opinion. WE work with the Cardiology Dept. to define those parameters. What we are not doing is relying on finding that Des Spence had evidence for in his article to be wrong half the time - and wrong half the time means a random diagnosis!. John |
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