title: Family physicians' ability to detect a physical sign (hepatomegaly) from an unannounced standardized patient (incognito SP).
abstract: BACKGROUND
  Little is known about the quality of the physical examination and its effectiveness in daily practice.
  
  
  OBJECTIVE
  To determine if family physicians (FPs) were able to detect an important physical sign (hepatomegaly) and to relate this result with other measures of quality.
  
  
  METHODS
  57 of 104 invited FPs from the National Health Service of the Southern Barcelona Area agreed to schedule an unannounced Standardized Patient (SP) randomly into their daily practice. The SP presented with hepatomegaly and mild abdominal pain. After the visit clinical notes, medical orders, an audiotape of the visit and a checklist completed by the SP detailing items in the physical examination (PE) were analysed. The attainment of a number of quality standards was assessed.
  
  
  RESULTS
  The three major findings that resulted from this study were: (a) only 4 of the 57 FPs who examined the patient detected the hepatomegaly; (b) FPs performed better at history taking (84.24%) than at PE (26.35%); no correlation was found between the two; (c) diagnostic accuracy was associated with older age, years of experience, history taking skills and better performance at requesting diagnostic tests. Most FPs (88%) requested the appropriate tests. FPs who scored better on requesting diagnostic tests spent an average of four minutes more with the patient. None of the participants detected the SP.
  
  
  CONCLUSIONS
  Clinical hepatomegaly is difficult to detect, even by well trained FPs. Senior doctors scored better on physical examination.
authors.affiliation: Clinical Sciences Department Campus Bellvitge, Faculty of Medicine, University of Barcelona, Catalan Institute of Health (ICS), Barcelona, Spain. fborrell.cp.ics@gencat.cat
authors.forename: Francisco
authors.initials: F
authors.lastname: Borrell-Carrió
authors.forename: Benilde Fontoba
authors.initials: BF
authors.lastname: Poveda
authors.forename: Elena Muñoz
authors.initials: EM
authors.lastname: Seco
authors.forename: Jose Antonio Prados
authors.initials: JA
authors.lastname: Castillejo
authors.forename: Miguel Pedregal
authors.initials: MP
authors.lastname: González
authors.forename: Eva Peguero
authors.initials: EP
authors.lastname: Rodríguez
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000367:Age Factors; D005194:Family Practice / Q000379:methods / Q000592:standards; D005260:Female; D006529:Hepatomegaly / Q000175:diagnosis*; D006801:Humans; D008487:Medical History Taking / Q000592:standards; D008875:Middle Aged; D016544:Patient Simulation; D010808:Physical Examination / Q000592:standards*; D010821:Physicians, Family / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards; D011787:Quality of Health Care; D013030:Spain; D013637:Tape Recording