Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation

JAMA Cardiology
Jagat NarulaEugene Braunwald

Abstract

Inspection, palpation, percussion, and auscultation have been the 4 pillars of clinical bedside medicine. Although these basic methods of physical examination have served us well, traditional bedside examination, for a number of reasons including diminishing interest and expertise, performs well less than what is required of a modern diagnostic strategy. Improving the performance of physical examination is vital given that it is crucial to guide diagnostic possibilities and further testing. Current efforts at improving physical examination skills during medical training have not been very successful, and incorporating appropriate technology at the bedside might improve its performance. Selective use of bedside ultrasound (or insonation) can be one such strategy that could be incorporated as the fifth component of the physical examination. Seeing pathology through imaging might improve interest in physical examination among trainees, and permit appropriate downstream testing and possibly superior decision making. Current ultrasound technology makes this feasible, and further miniaturization of ultrasound devices and reduced cost will allow for routine use at the bedside. It is time to have a wider debate and a possible consensus...Continue Reading

Citations

Sep 7, 2018·Current Opinion in Nephrology and Hypertension·William Beaubien-SoulignyAndré Denault
Jun 8, 2018·Postgraduate Medical Journal·Antonio J Martín-JiménezDaniel García-Gil
Dec 30, 2018·Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine·Graham W W Van SchaikMichael C Murphy
Oct 24, 2018·European Heart Journal Cardiovascular Imaging·Nuno CardimBogdan A Popescu
Mar 29, 2019·Clinical Journal of the American Society of Nephrology : CJASN·W Charles O'Neill, Daniel W Ross
Aug 6, 2019·Annals of Internal Medicine·Nir Flint, Robert J Siegel
Jun 5, 2019·Korean journal of anesthesiology·André DenaultCaroline E Gebhard
Jan 1, 2020·European Journal of Heart Failure·Luna GarganiPeter S Pang
Nov 24, 2019·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Jennifer PalermoAndré Y Denault
Aug 28, 2019·Respirology : Official Journal of the Asian Pacific Society of Respirology·José M Porcel
Jun 10, 2020·European Heart Journal Cardiovascular Imaging·Luna GarganiMatteo Cameli
Sep 2, 2020·Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology·D BuonsensoF Moro
Jul 7, 2018·Southern Medical Journal·Michael Wagner, Janice Boughton
Nov 5, 2019·Regional Anesthesia and Pain Medicine·Jan Boublik, Stephen C Haskins
Aug 9, 2020·Pediatric Quality & Safety·Eric ScheierUri Balla
Jun 28, 2019·Science Translational Medicine·Eric J Topol
Jul 10, 2020·Jornal brasileiro de nefrologia : ʹorgão oficial de Sociedades Brasileira e Latino-Americana de Nefrologia·Ana Cláudia da SilvaMarcus Gomes Bastos
Jun 27, 2018·Intensive Care Medicine·Karan Singh, Paul Mayo
Sep 5, 2019·São Paulo Medical Journal = Revista Paulista De Medicina·Gabriela Araújo AttieRonald Luiz Gomes Flumignan
Mar 4, 2020·European Heart Journal. Case Reports·Jonathan Dos SantosAlexandra Gonçalves
Sep 16, 2020·Regional Anesthesia and Pain Medicine·Michelle S KarsKaren Boretsky
May 31, 2020·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Jesper WeileHans Kirkegaard
Nov 12, 2020·Clinical Cardiology·Muhammad HammadahMario Gössl
Nov 20, 2020·Pediatric Radiology·Rick R van RijnUNKNOWN European Society of Paediatric Radiology
Jan 24, 2021·Critical Care : the Official Journal of the Critical Care Forum·Laurent ZieleskiewiczMarc Leone
Nov 11, 2020·Journal of Cardiothoracic and Vascular Anesthesia·Sheldon GoldsteinKumar Vivek
Nov 22, 2020·The American Journal of Medicine·Daniel M Gelfman
Mar 15, 2021·Indian Heart Journal·Jorge I ParrasEduardo R Perna
Jul 12, 2020·Revista clínica española·Juan Torres Macho, Gonzalo García de Casasola Sánchez
Apr 8, 2021·Education for Primary Care : an Official Publication of the Association of Course Organisers, National Association of GP Tutors, World Organisation of Family Doctors·Sophia KerznerJason Profetto
Apr 20, 2021·ATS Scholar·Neha Bansal Etherington, Cameron Baston
May 18, 2021·Current Emergency and Hospital Medicine Reports·Adrienne N MalikRobert R Ehrman
Jun 29, 2021·Hospital Practice·Shahraz QamarSalim Surani
Jul 15, 2021·Semergen·C Vale VarelaA López Villalvilla

❮ Previous
Next ❯

Related Concepts

Related Feeds

Cardiology Journals

Discover the latest cardiology research in this collection of the top cardiology journals.

Related Papers

Wiadomości lekarskie : organ Polskiego Towarzystwa Lekarskiego
S Sliwiński
Wiadomości lekarskie : organ Polskiego Towarzystwa Lekarskiego
S Sliwiński
Kansas Medicine : the Journal of the Kansas Medical Society
W E Meyer
© 2022 Meta ULC. All rights reserved