The article ‘Bad medicine: clinical examination’ might have made me chuckle at the imaginative use of Harry Potter references but it did not persuade me to change my clinical practice.1 The author seems to equate disdain for the perceived hierarchical teaching and comment from medical schools and royal colleges as proof that clinical examination has no relevance.
He suggests that we ‘embrace technology’ and cites how CT and MRI have blown away the pomposity of consultants; both these things may have merit but they do not mean that examination is without value. He is right that it is dangerous to rely on clinical examination. But a good clinician will take a full history and enhance that with appropriate examination; there is no absolute reliance. As a GP, I don’t have access to investigations during a consultation; examination helps to determine whether an illness can be managed in primary care or needs to be referred for further investigation or secondary care consultation and whether such referral should be routine or urgent.
He again highlights intimate examination such as pelvic examination (bimanual examination +/− visualisation of the cervix).2 The evidence that this examination is of no benefit to asymptomatic women is clear, but to suggest that pelvic examination has no place in the management of symptomatic women is cause for concern. There has been little research conducted into the role of pelvic examination in primary care so evidence is limited, but what evidence there is supports the use of pelvic examination prior to referral.3 There is nothing illogical about using pelvic examination to determine if a patient’s postcoital bleeding is caused by a cervical ectropion or polyp or a possible cervical cancer.
- © British Journal of General Practice 2017