The Science of the Art of the Clinical Examination

Our first moments with a patient are packed with visual, auditory, and tactile information that determines both the effectiveness and the costs of our subsequent care. Of all the diagnoses that ever will be made, most are made during the history, and most of the rest during the physical examination. For example, Crombie1documented that 88% of diagnoses in primary care were established by the end of a brief history and some subroutine of the physical examination. Similarly, Sandler2found that 56% of patients in a general medical clinic had been assigned correct diagnoses by the end of their history, and that this figure rose to 73% by the end of their physical examination. Even when patients are referred to See also pp 2638 and 2645. specialty centers after exhaustive workups elsewhere, attention is appropriately refocused on the clinical examination: the patient's "story" and the physical examination. Indeed,