[Continuing importance of the clinical approach. Observations on a regional collaboration between general practitioners, internists and cardiologists].

The advent of high-tech diagnostic methods raises concerns nowadays about the value of the clinical approach and bedside diagnosis. This at least is the impression given by modern scientific literature, which rarely even mentions this part of examination of the patient. In order to define the actual role played by auscultation in the management of cardiological patients by the primary care physician, the records of 250 patients consecutively referred to a cardiologist are analyzed. The practitioner's initial clinical diagnosis is compared to the final cardiological diagnosis. Per referred patient, 1.76 specialized consultations were needed. In 64% of the cases only one such consultation took place. Initial diagnosis was correct in 80% of all cases, partly correct in 11% and incorrect in 9% of the cases. Out of the 64 cases of valvular diseases, 33 were initially correctly recognized by the physician. The cardiological investigation was also invasive in 6.5% of all cases, 4.5% of the patients eventually undergoing invasive or surgical treatment. Thus the great majority of the patients (93.5%) were managed by the primary physician with "first-line" cardiologist's support, which was often only occasional (only one specialized consultation in about two thirds of all cases). This highly independent and presumably cost-effective patient management by the primary care physician implies a high level of clinical skill. It stresses the outstanding importance of continuing teaching of the clinical approach and particularly of cardiac auscultation, which is still the best screening method for valvular heart disease.