The Clinical Examination An Agenda to Make It More Rational

JAMAintroduced The Rational Clinical Examination series in 1992. The founder of the series, David Sackett, writing with one of us1(D.R.), observed that the history and physical examination (together, the clinical examination) frequently supplied all that was needed for a diagnosis, permitted physicians to rule out diagnostic hypotheses, could identify patients at early stages of their diseases, and played an important role in developing rapport with the patient. See also p 564. Sackett and Rennie noted that though facts gleaned from the clinical examination were like laboratory tests in that they had measurable sensitivities, specificities, and predictive powers, investigation of the precision and accuracy of the clinical examination had lagged behind that of more expensive (and perhaps less therapeutic) laboratory tests. They suggested this was because such investigation was arduous and not easily undertaken by those taught to rely on the laboratory; because the clinical diagnosis rarely resides