Physical examination in the care of medical inpatients: an observational study.
BACKGROUND
Little is known about the clinical importance of skilled physical examination in the care of patients in hospital.


METHODS
Hospital records of a systematic consecutive sample of patients admitted to a general medical inpatient service were reviewed retrospectively to determine whether physical findings by the attending physician led to important changes in clinical management. Patients with pivotal physical findings were defined by an outcomes adjudication panel as those whose diagnosis and treatment in hospital changed substantially as a result of the attending physician's physical examination. Pivotal findings were classed as validated if the resulting treatment change involved the active collaboration of a consulting specialist. Findings were classed as discoverable if subsequent diagnostic testing (other than physical examination) would probably have led to the correct diagnosis. Class 1 findings were those deemed validated but not discoverable.


RESULTS
Among 100 patients, 26 had pivotal physical findings (26%; 95% CI 18-36). 15 of these (58%; 95% CI 37-77) were validated (13 with urgent surgical or other invasive procedures) and 14 were discoverable (54%; 95% CI 33-73). Seven patients had class 1 findings (7%; 95% CI 3-14).


CONCLUSIONS
Physical examination can have a substantial effect on the care of medical inpatients. If replicated in other settings, these findings might have important implications for medical educators and quality improvement initiatives.
Reilly
Brendan M
BM
Department of Medicine, Cook County Hospital and Rush Medical College, Chicago, Illinois, USA. breilly@cchil.org
D002983:Clinical Competence; D003937:Diagnosis, Differential; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000145:classification*; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D005791:Patient Care / Q000379:methods*; D010808:Physical Examination / Q000379:methods / Q000592:standards*; D012189:Retrospective Studies