title: Bedside Diagnosis in the Intensive Care Unit. Is Looking Overlooked?
abstract: Bedside diagnosis, including but not limited to the physical examination, can be lifesaving in the setting of critical illness and is a core competency in both medical school and at the postgraduate level. Data as to the clinical usefulness of bedside diagnosis in the modern intensive care unit (ICU) is sparse, however, and there are no clinical guidelines addressing performance, interpretation, and usefulness of the bedside assessment in critically ill patients. Bedside assessment and physical examination are used in a heterogeneous manner across institutions and even across ICUs within the same institution, which has implications for medical education, patient care, and the overuse/misuse of diagnostic testing. In this commentary, we review the existing data addressing bedside diagnosis in the ICU, describe various models of bedside assessment use in the ICU based on our clinical practice and on the limited evidence base, share our practical "checklist-based" approach to bedside assessment in the critically ill patient, and advocate for more formal study of physical examination and bedside assessment in the ICU to enhance clinical practice.
authors.affiliation: 1 Division of Cardiology and.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Metkus
authors.affiliation: 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Bo Soo
authors.initials: BS
authors.lastname: Kim
mesh_terms: D002983:Clinical Competence; D003422:Critical Care / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D010817:Physician-Patient Relations; D019095:Point-of-Care Systems / Q000592:standards*
keywords: bedside diagnosis; clinical skills; critical care; patient–physician relationship; technology