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Clinical examination: evidence and eminence

We introduce a new MJA series outlining essential clinical skills for generalists, doctors in training and medical students

Medicine is a science of uncertainty and an art of probability
– Sir William Osler1

All clinicians and medical students are excited when they make a diagnosis from taking a patient’s history or after a physical examination. Most diagnoses can be made by taking a full history followed by targeted clinical examination.2 If and when necessary, this can be followed by appropriate cost-effective investigations. A targeted and thorough physical examination can avoid the ordering of inappropriate tests that return results that are very difficult or impossible to interpret. Inappropriate tests often lead to further tests to try to clarify unexpected (and usually false-positive) results. In the past, investigations used to follow and complement, rather than replace, clinical examination.

We need to bring this philosophy back to medicine to save costs and connect with our patients. For example, if you hear a systolic murmur at the apex and are not sure whether it results from aortic stenosis or mitral regurgitation, by all means confirm the diagnosis with an echocardiogram. But be sure to refine your clinical acumen. For example, if you thought it was…