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.
Medical tests ordered on the day of hospital discharge have a high risk of not being followed up on by the ordering physician, reports Mei-Sing Ong, PhD in a research letter in the Archives of Internal Medicine on August 13th. Of 662,858 tests ordered for 6736 patients during their hospitalization, 3.1% of test results did not get reviewed before discharge. Two months later, half of those were still not reviewed. More than one-third of patients had at least one test result that was not reviewed prior to discharge. Most of the test results that went unreviewed were ordered on the day of discharge.