Des Spence questions the value of clinical examination and claims that ‘... the most common defence is that doctors need these “skills” to work in low-income countries’.1 This is untrue. Practitioners, when making a clinical decision with patients, need to incorporate all the tools available to them, including the patient’s background, a focused history, and a clinical examination. The thought processes of many junior hospital doctors are echoed by Dr Spence. As a result departments become saturated, tests beget tests, and decisions spiral ever upwards. One of the first lessons of a new GP registrar is to ‘unlearn’ this mindset.
A reassuring history and negative examination allow us to use time. Conversely, a worrying history especially with demonstration of hard physical signs guides us to the next stage. The skill then becomes ‘when to do what’. Patients have a right to expect their GP to recognise serious illness: the ‘rare but important’ if you like. In adults the acute physicians now use a generic National Early Warning Score to spot such cases. Guess what? The parameters are clinical.2 Please don’t throw your stethoscopes and thermometers away yet. When the chips are down you may one day need them.
- © British Journal of General Practice 2017