Physical examination is becoming a lost art and used less and less as technology driven medicine replaces clinical assessment. A recent article in the Washington Post highlighted the waning ability of doctors to use physical examination to make an accurate diagnosis. Over the past few decades, the physical diagnosis skills of physicians has decreased while the use of a dizzying array of sophisticated expensive tests has increased dramatically. Many healthcare organizations downplay the physical exam and think it superfluous compared to medical testing. Often, however, when technology is used without bedside skills, it takes the physician down a path where tests cause more tests to be ordered and, at the end after all the delay, the patient either sees a surgeon, a lawyer or an undertaker.
Surgery to remove partial meniscal tears does not result in better knee function than medical treatment and physical therapy alone. Arthroscopic partial meniscectomies are one of the most common orthopedic procedures performed each year in the United States at a cost of $4 billion. These results of this study in the December 26, 2013 issue of the New England Journal of Medicine raise serious questions about the cost effectiveness of this surgical treatment and the ethics of using it as a future treatment.