An editorial lamenting poor clinical skills provided grist for discussion among several blogs last week. The controversial article in question was just an opinion piece. But that opinion may be evidence based according to last week’s Archives of Internal Medicine. With the exception of cardiology attendings and fellows, cardiac physical examination across the career spectrum never improved beyond the junior medical student level in this study. Even teaching faculty proved no better than medical students. To me the most telling finding was that participants could correctly differentiate systolic from diastolic sounds only 66% of the time!
The power of physical examination of the heart was shown in this related article which evaluated the third heart sound (S3) as a test. Although not very sensitive, the S3 showed high specificity in predicting elevated BNP, elevated filling pressure and systolic dysfunction.
Findings such as this motivate me to improve my basic clinical skills. With basic knowledge and skill in clinical medicine come power. I’m preaching to myself here. David L. Simel provides editorial commentary on the two studies.