Physical Exams: Where’s the Beef?
Written by Editor   
Friday, April 24, 2015 12:00 AM

The recent flurry about the pros and cons of physical examinations has been informed by another timely publication. The authors make some critical points that should be considered in the current debate.  First, they say, “physical examination might represent waste when applied without context.”  That is exactly why the physical exam has lost traction as the “yearly physical,” which definitely lacks context.

Second, “we need to shift our emphasis . . . [and ask for] more robust evidence basis.”

The authors decry the sparse evidence-based data regarding the physical exam. They ask for larger prospective studies, and I say here, here! How much of what we do on physical exam is valuable and how much is waste?

Enter a new approach: the Evidence-Based Physical Examination.  We need more evidence-based physical examination studies that are well designed. Many do not warrant serious review. There is waste in our exams. Of the many maneuvers clinicians do for shoulders, a substantial portion has zero data to support value. Only those that have scientific merit should be used. It is high time we neither “praise nor bury” the physical examination, but rather determine its scientific efficacy in specific contexts.