Icahn School of Medicine at Mount Sinai, New York, New York.
University of Minnesota School of Medicine and Veterans Affairs Medical Center, Minneapolis.
JAMA Cardiol. 2018 Apr 1;3(4):346-350. doi: 10.1001/jamacardio.2018.0001.
Inspection, palpation, percussion, and auscultation have been the 4 pillars of clinical bedside medicine. Although these basic methods of physical examination have served us well, traditional bedside examination, for a number of reasons including diminishing interest and expertise, performs well less than what is required of a modern diagnostic strategy. Improving the performance of physical examination is vital given that it is crucial to guide diagnostic possibilities and further testing. Current efforts at improving physical examination skills during medical training have not been very successful, and incorporating appropriate technology at the bedside might improve its performance. Selective use of bedside ultrasound (or insonation) can be one such strategy that could be incorporated as the fifth component of the physical examination. Seeing pathology through imaging might improve interest in physical examination among trainees, and permit appropriate downstream testing and possibly superior decision making. Current ultrasound technology makes this feasible, and further miniaturization of ultrasound devices and reduced cost will allow for routine use at the bedside. It is time to have a wider debate and a possible consensus about updates required to enhance current paradigms of physical examination.
视诊、触诊、叩诊和听诊一直是临床床边医学的 4 大支柱。尽管这些基本的体格检查方法对我们很有帮助，但由于多种原因，包括兴趣和专业知识的减少，传统的床边检查的表现远不如现代诊断策略所要求的那样好。鉴于体格检查对于指导诊断可能性和进一步检查至关重要，因此提高体格检查的表现至关重要。目前在医学培训中提高体格检查技能的努力并没有取得很大成功，在床边引入适当的技术可能会提高其性能。选择性地使用床边超声（或超声探查）可以作为体格检查的第五个组成部分。通过影像学观察病理变化可能会提高受训者对体格检查的兴趣，并允许进行适当的下游检查，并可能做出更好的决策。当前的超声技术使这成为可能，而且超声设备的进一步小型化和成本降低将允许在床边常规使用。现在是时候就更新当前体格检查范式所需的内容进行更广泛的辩论和可能的共识了。
