The bedside evaluation: ritual and reason.
Summary of "The bedside evaluation: ritual and reason."
The bedside evaluation, consisting of the history and physical examination, 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 recognizable disease, physicians who forgo or circumvent the bedside evaluation 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 complete 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.
Affiliation
Stanford University School of Medicine and Stanford University, Stanford, California; Western Kentucky University, Bowling Green, Kentucky; and GlaxoSmithKline, King of Prussia, Pennsylvania.
Journal Details
This article was published in the following journal.
Name: Annals of internal medicine
ISSN: 1539-3704
Pages: 550-3
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22007047
- DOI: http://dx.doi.org/10.1059/0003-4819-155-8-201110180-00013
Medical and Biotech [MESH] Definitions
Evaluation Studies As Topic
Studies determining the effectiveness or value of processes, personnel, and equipment, or the material on conducting such studies. For drugs and devices, CLINICAL TRIALS AS TOPIC; DRUG EVALUATION; and DRUG EVALUATION, PRECLINICAL are available.
Program Evaluation
Studies designed to assess the efficacy of programs. They may include the evaluation of cost-effectiveness, the extent to which objectives are met, or impact.
Ilex Guayusa
A plant species of the family AQUIFOLIACEAE known for ritual use by Amazonian Jivaro Indians.
Self-evaluation Programs
Educational programs structured in such a manner that the participating professionals, physicians, or students develop an increased awareness of their performance, usually on the basis of self-evaluation questionnaires.
Point-of-care Systems
Laboratory and other services provided to patients at the bedside. These include diagnostic and laboratory testing using automated information entry.
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