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It was a pleasure to read Brettell’s call to arms about the importance of clinical examination skills for GPs.1 I am fortunate to work in a practice where three of us first passed the MRCP en route to entering our chosen profession as GPs. In an age of apparent demoralisation among GPs, the challenge and enjoyment of clinical diagnosis is a useful daily antidote. I still remember, as a GP trainee, debating with my trainer, months before his retirement, about whether a patient had a pleural effusion or consolidation. The chest X-ray proved him right, as he still reminds me in Christmas cards. Conversely, I also recall with satisfaction detecting the murmur of aortic regurgitation in my first months as a GP partner. My predecessor had passed the heart sounds as normal. The teddy bear from the hospital trolley, bought for me by the patient after her valve replacement, still cheers up grizzly toddlers in my consulting room. We teach third- and fifth-year medical students from Keele University during impressively long attachments in general practice, and I am often struck how cursory their examination techniques can be. Percussion of the chest, for example, seems to be regarded as alien to the general practice setting.
Perhaps the College should review its CSA scenarios and incorporate some that require demonstration of sound clinical examination skills.
- © British Journal of General Practice 2016
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