In my opinion, Knut, the physical examination is the part of the consultation most neglected in doctor training.
Probably there are many excellent exceptions to the statement above. I was medical orderly in Umeå 1957. Many prominent doctors came and went. I attended in the consultations.
It was obvious from the consultations that some physicians relied mainly on patient history, others on physical examination, still others on laboratory tests.
By and large, the consultation game resembled Chaos Park (Rondel 2000;2:Health). You improve your good techniques and become still better. You neglect your poor techniques and…
To hear and read a patient, to make a psychoscopy from scalp to toe, you need at least ten minutes. A meticulous physical examination can be performed in two minutes.
The secret of swift search is structuring of observations. When the patient rises to shake hands, he shows the function of knees, hips, low back, and hand.
When the patient introduces himself, the smell of smoking, garlic, snuff, spirits, acetone is identified and quantified by the professional nose.
The first puffing and panting are provoked by a quick walk to the examination room. When the patient undresses and re-dresses, he provides information on balance and mobility.
The point is that history and physical examination supplement each other. A patient jogging 5 km in 20 minutes probably has a healthy heart.
Of course! There are text-books. But no footballer in the league relies entirely on lectures and scientific literature. The main part of the training is practical – endurance, technique, co-operation. Life is grim!
As a rule of thumb, it is better to read the man than his chart. But everything read in a man cannot be recorded in his chart.
Many old patient charts are splendid from a literary point of view but criminal from a legal point of view. "History – misery and groan! Observations – a picture of health".
Knut, we old trainers must realize that progress progresses. Cars become better and cheaper, the students more brilliant, the patients older. The model of yesterday is the cautionary of tomorrow.
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Updated januari 10, 2001