Des Spence’s article regarding clinical examination,1 in my opinion, described a poorly considered viewpoint. In fact, in the same edition, a letter was published2 that reflected my own view that clinical examination is paramount, especially in the isolated setting.
Working in the military environment, resources and investigative tests are limited. Purely on the basis of a history and clinical examination, I have to make a decision regarding whether my patient is fit to remain deployed in an austere environment or must return to the UK. Occasionally, this decision can impact on the ability of the military unit to carry out their tasking, which has impact beyond the individual patient. Without a firm grounding in clinical examination, I would not be able to adequately perform my job role, both caring for my patients and providing medical advice to the command team and supporting my unit on operations.
Yes, relying purely on clinical examination is dangerous, but so is relying on technology: it can break, can be unavailable, and is expensive! A doctor should have the knowledge and skills to formulate a differential diagnosis based on history and examination alone, and utilise focused investigations where possible to prove the diagnosis and/or direct the management of the case. Patients expect this and respect our abilities as doctors. In this increasing time of stretched resources, the ‘dark art’ of clinical examination, although not ideally sensitive or specific, at least is quick and cheap, and a key skill that all doctors should seek to perfect.
- © British Journal of General Practice 2017
