What has become of the physical examination?

Article Abstract:

The common approach to evaluating a patient consists of a physical examination, recording the patient's clinical history, and performing carefully chosen diagnostic tests. Physical diagnosis continues to be routinely taught in medical schools, and techniques and procedures have remained the same over the past 25 years. However, the self-image of the young physician has changed, and medical students tend to be overwhelmed by the mass of medical information. In contrast to highly technical diagnostic techniques, the physical examination is easily performed using the eyes, hands, ears, nose, and simple equipment. Many childhood diseases can be adequately diagnosed by physical examination. However, in many teaching hospitals, a diagnosis without a single diagnostic test may be considered unacceptable. Even when a correct diagnosis is made on the basis of a physical examination, other tests may be required to confirm the diagnosis, leading to increased medical costs. The elimination of incorrect diagnoses also results in higher costs. In addition, physicians are constantly reminded of the legal implications of not performing all necessary diagnostic tests. The physical diagnosis may often be rushed so that a patient can proceed to diagnostic testing. Frequently, the patient may reach the radiology department without having a history taken, and the radiologist is then required to perform the physical diagnosis. This results in elevated health care costs, an increased workload for diagnostic staff, and less time for truly sick children who need complete medical and diagnostic evaluations. Finally, overzealous diagnostic testing may wear on the patience of children, most of whom do not have a complex disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Economic aspects, Pediatric diseases, Diseases, Diagnostic imaging, Physical diagnosis, Medical examination, Diagnosis, editorial

---

Esophageal obstruction and abscess formation secondary to impacted, eroding tiddlywink: radiological case of the month

Article Abstract:

The case of a four-year-old boy admitted to the hospital for acute dehydration is described. Over the previous six months he had been consuming smaller and smaller quantities of food, although he was able to take liquids well. An esophagogram was performed and showed a mass obstructing the esophagus, the muscular tube that carries food from the mouth to the stomach. A computed tomographic scan showed displacement of the trachea (windpipe), as well as swallowed contrast material filling the mass. The magnetic resonance image showed that the mass contained a disk-like foreign body. At operation a one-inch plastic disk called a tiddlywink was removed. This had obstructed the esophagus and caused an abscess to form. Although young children frequently swallow small objects, it is uncommon for the object to become impacted. An impacted object may wear away the esophagus or puncture it if the object is sharp. Symptoms can include wheezing, refusal to eat, drooling, pain on swallowing, vomiting and altered consciousness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Case studies, Injuries, Pediatric injuries, Esophagus, Ingestion disorders, Foreign bodies (Medical care), Foreign bodies

---

Similar abstracts:

• Abstracts: What does Cruzan mean to the practicing physician? Effects of patient age and physician training on choice and dose of benzodiazepine hypnotic drugs
• Abstracts: Incidence of lingual nerve trauma and postinjection complications in conventional mandibular block anesthesia
• Abstracts: Anaemia of rheumatoid arthritis: serum erythropoietin concentrations and red cell distribution width in relation to iron status
• Abstracts: An analysis of abnormalities of the retinoblastoma gene in human ovarian and endometrial carcinoma. Kaposi's sarcoma in patients with acquired immune deficiency syndrome: a flow cytometric DNA analysis of 26 lesions in 21 patients
• Abstracts: Where should the research dollars go? Patients' lack of literacy may contribute to billions of dollars in higher hospital costs

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.