Role of clinical examination in patient care

1. ROLE OF CLINICALEXAMINATION IN PATIENT CARE
Dr.T.V.Rao MD
I was a Medical student in 1969, posted for learning bed side medicine in a Government Hospital
Belgaum, Karnataka , Our teachers were knowledged, and committed to the punctuality, we were
all expected to be presentourselves in Time with bright faces to create some hope in the patients at
the first instance, Making us to realise HOPE is the best word in Medicine and rest all secondary as
we had few drugs to treat the patients and rarely investigated , however on many occasions
patients were awaiting for our presence, Our chief’s used to introduce that we are future Doctors so
save many in the world, and He or She should cooperate with them, it was great boost for all of us,
no patient refused to accept us as Junior Doctors, they used to tell their personal problem and later
we used to convey to our chiefs the hidden History of the patients ailments. I always felt Medicine is
a Clinical skill and not in book or great volumes in Library. My most memorable teacher was Late S.J.
Nagalotimath the Pathology Professor he used to take us to Pathology museum and teach us so
many facts beyond pathology, He used to take a specimen mounted with Cancer lung, and tell us,
there is nothing in this lung expect morbid facts, the problem is with pollution, and smoking. Today
how many teachers we find, like him in the country to remember. Nowit is rare to find Professors
getting up from their chair, and wish only to command respect for the position and not for
contributions. I am proud to be student of J.N Medical College, Belgaum, our Museums in Anatomy
and Pathology are marvels in teaching than morbid knowledge, everything was actively clinical
dissemination of Knowledge and they live after the doyens who have done it. Today after 4 decades,
being in Profession in abroad and India the poor quality of Doctors in India is due lack of skills and
poor clinical knowledge , In beginning just knowing little Clinical observation has been a part of
medicine since Egyptian, Babylonian, Chinese and Indian physicians began examining the body
thousands of years ago. Clinical reasoning and bedside diagnosis first played a role in ancient Greece
when Hippocrates began measuring body temperature, evaluating the patient’s pulse and palpating
the abdomen. But it wasn’t until the 19th century that physical diagnosis exploded, with such
developments as percussion and auscultation—the tapping and listening those physicians still
practice. Sir William Osler, M.D., often described as the father of modern medicine, told his
students: “He who studies medicine without books sails an uncharted sea, but he who studies
medicine without patients does not go to sea at all.” Medical college faculty continue to dole out
such advice to their students today. We cannot underestimate the power of technological advances
in the modern times as “We have technology that allows us to see things we could never see before,
hear things we could never hear before. So in a sense technology has expanded our ability to replace
a certain sector of the examination with either visual data or other kinds of data that weren’t
available to us. Today many patients think that we are Technicians ordering test without examining
them or even talking to them, Osler was a pioneer in this area, advocating clinical demonstrations in
the third year of medical school and clinical clerkships in the fourth. The current model came into
use in the 1950s, with schools moving the clerkships to the third year and the fourth year devoted to
hospital rotations. But because these experiences varied so much from institution to institution,
clinical education came under closer scrutiny. Between the 1980s and the early 1990s, five major
reports focusing on the quality of medical education were issued—see today many Physicians are
already with diagnostic requisition from before the patient tells few words. The problem with
technology arises when doctors rush to order tests without first performing a thorough physical

2. exam. Doctors may be overly reliant on tests because they have confidence in the results; however,
tests aren’t always accurate. Lyme disease, or Typhoid common cold, for example, often hasthe
differentclassic signs of rash, fever and muscle aches, pattern of temperature yet the blood tests are
often negative.Many sensible Doctors added, allows for optimal use of the physical exam and more
selective use of technology. Think before you write elaborate diagnostic tests, Studies have
consistently shown that the patient’s history and physical examination are the most important
factors in arriving at a correct diagnosis, whereas lab tests and imaging studies play complementary
roles, and that excessive reliance on technology hasn’t necessarily improved the quality of patient
care. Many think “We have to work hard to reinforce both the approach to patient care and the
specific physical exam skills that are taught in the preclinical years to show students their usefulness
and effectiveness at the bedside. But it’s hard to deny the importance of learning those skills and
having an opportunity to practice them again and again if they are to remain useful. “Medicine is
learned by the bedside and not in the classroom. Let not your conceptions of disease come from
words heard in the lecture room or read from the book. See, and then reason and compare and
control,” Osler told his students. Just remember one thing. Whether the patient is a patient in real
life, or a patient in an exam, they are a human being. A person. At some point, they'll be you. I learnt
many things as a Microbiologist that everything in Medicine is clinical and Human it is not urine,
blood or excreta, just realise there is some lesson behind everything we analyse, "Always listen to
the patient, they might be telling you the diagnosis. William Osler. The best words I listened in my
life from Dr Bhat a Renowned urologist spoke at SVIMS Tirupati on his life time achievement, Just
Doctor realise you may be on other side of the Table, Throughout his career, he was a defender of
patients' rights and prerogatives. The very work culture of his department was a potent validation of
such rights; no surgery was ever performed without a succinct and decipherable explanation of the
planned procedure to the patient. And, he insisted that we pay attention to drafting exquisite
discharge summaries loaded with strategic details. The summaries were always scrutinised and
amended further by Dr. Bhat, who removed verbiage, and added greater reasoning. Another great
Teacher and an Urologist I am associated with Dr. K. Sasidharan, our Dean at SVIMS Tirupati, AP he
used to tell me any one can become a famous in any speciality ifone have respect for the Human
being and the tissues you operate. I wish to express to my students, Listen to the patient, practice a
human touch and try to solve the problem, above all in all our actions God is with us?
Dr.T.V.Rao MD Professor of Microbiology, Freelance writer.