The Bedside Evaluation: Ritual and Reason
BibTeX
@MISC{Verghese_thebedside,
author = {Abraham Verghese and Md Erika Brady and Phd Cari and Costanzo Kapur and Ralph I. Horwitz},
title = {The Bedside Evaluation: Ritual and Reason},
year = {}
}
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Abstract
The bedside evaluation, consisting of the history and physical ex-amination, was once the primary means of diagnosis and clinical monitoring. The recent explosion of imaging and laboratory testing has inverted the diagnostic paradigm. Physicians often bypass the bedside evaluation for immediate testing and therefore encounter an image of the patient before seeing the patient in the flesh. In addition to risking delayed or missed diagnosis of readily recogniz-able disease, physicians who forgo or circumvent the bedside eval-uation risk the loss of an important ritual that can enhance the physician–patient relationship. Patients expect that some form of bedside evaluation will take place when they visit a physician. When physicians com-plete this evaluation in an expert manner, it can have a salutary effect. If done poorly or not at all, in contrast, it can undermine the physician–patient relationship. Studies suggest that the context, locale, and quality of the bedside evaluation are associated with neurobiological changes in the patient. Recognizing the importance of the bedside evaluation as a healing ritual and a powerful diagnostic tool when paired with judicious use of technology could be a stimulus for the recovery of an ebbing skill set among physicians. Ann Intern Med. 2011;155:550-553. www.annals.org
Keyphrases
bedside evaluation physician patient relationship laboratory testing physical ex-amination ebbing skill primary mean powerful diagnostic tool ann intern med judicious use important ritual bedside eval-uation risk clinical monitoring immediate testing diagnostic paradigm neurobiological change recent explosion salutary effect expert manner recogniz-able disease
