Bad medicine: chest examination

Respiratory and cardiac assessment are central to clinical examination. As a student I always agreed that I had heard murmurs, crepitations, and rubs, even when I hadn’t. Good doctors found signs, and I didn’t want to look stupid. When I started work I noticed that colleagues changed their recorded findings after chest radiography; signs moved from left to right, and effusion appeared where none was recorded before. Good doctors were cheating, and in the real world I missed pneumothoraces, heart failure, embolisms, and effusions on clinical examination. What I had …