The Enduring Importance of Clinical Examination

Abstract

The authors of a recent paper on clinical examination quoted William Osler: ‘medicine is learned by the bedside and not in the laboratory’. There are current concerns, particularly in the United States, about the preservation of high-quality clinical examination. There is a consensus that clinical skills have been deteriorating over the past 20 years. The reasons for this deterioration are complex.

The gravitational pull from the bedside towards imaging and laboratory investigations has resulted in medical students spending as little as 13% of their time with patients. This creep in the direction of a test-based approach to diagnosis has many downsides. Competency in clinical skills is adversely affected. This is important because half of outpatient errors are due to poor history taking and examination. The doctor-patient relationship is weakened and there is a decrease in empathy for the patient.