Elsevier

The Lancet

Volume 354, Issue 9191, 13 November 1999, Pages 1721-1724
The Lancet

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Why we need large, simple studies of the clinical examination: the problem and a proposed solution

https://doi.org/10.1016/S0140-6736(99)01174-5Get rights and content

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The problem stated

All physicians recognise (and most acknowledge) the importance of the initial clinical examination (history and physical) in the care of patients. The examination has several vital functions, in addition to establishment of rapport. For example, it usually provides a diagnosis: 88% of all diagnoses achieved in primary care1 and 73% in a general medicine clinic2 are established by the end of the initial history and physical examination. The initial clinical examination also allows us to identify

A possible solution

If this state of affairs is to change, we must begin highquality studies on a very large scale (so that our estimates of precison and accuracy have narrow CIs). Moreover, such studies have to be done among real-world patients in primary, secondary, and tertiary care (to show any changes in accuracy as patients move along the referral pathway). The studies must involve the broad array of real-world clinicians at various levels of training and experience, who are the targets for what is learned.

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