Garibaldi Brian T, Olson Andrew P J
Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, 1830 East Monument Street, 5th Floor, Baltimore, MD 21205, USA.
Division of General Internal Medicine, Department of Medicine, Office of Medical Education, University of Minnesota, 420 Delaware Street Southeast, MMC 284, Minneapolis, MN 55455, USA.
Med Clin North Am. 2018 May;102(3):433-442. doi: 10.1016/j.mcna.2017.12.005. Epub 2018 Mar 13.
The physical examination remains a vital part of the clinical encounter. However, physical examination skills have declined in recent years, in part because of decreased time at the bedside. Many clinicians question the relevance of physical examinations in the age of technology. A hypothesis-driven approach to teaching and practicing the physical examination emphasizes the performance of maneuvers that can alter the likelihood of disease. Likelihood ratios are diagnostic weights that allow clinicians to estimate the post-probability of disease. This hypothesis-driven approach to the physical examination increases its value and efficiency, while preserving its cultural role in the patient-physician relationship.
体格检查仍然是临床诊疗过程中的重要组成部分。然而，近年来体格检查技能有所下降，部分原因是床边检查时间减少。许多临床医生质疑在技术时代体格检查的相关性。一种基于假设驱动的体格检查教学和实践方法强调执行那些能够改变疾病可能性的操作。似然比是一种诊断权重，可让临床医生估计疾病的后验概率。这种基于假设驱动的体格检查方法提高了其价值和效率，同时保留了其在医患关系中的文化作用。
