Abraham Verghese Asks: “Why Are We Doing This Teaching?”

April 27, 2016

Errol Ozdalga, MD; @eozdalga
Clinical Assistant Professor, Stanford School of Medicine

We teach bedside medicine. We emphasize the importance of the physical exam and how it can help care for your patient and also create an environment where the person you are caring for develops trust. We have taught this now for over 6 years (when the Stanford Medicine 25 was first created). But sometimes it’s important to ask why. In a recent blog post, “Will the Healing Touch Go Out the Door With the Stethoscope?”, we look at the how some think that ultrasound is replacing any need for a stethoscope. One might argue that the stethoscope is a symbol for all of the physical exam. As ultrasound replaces stethoscope, so do MRI’s, CT’s and other technological advances replace the examination of the liver or the visualization of the retina. Combined with today’s physicians who are constantly being asked to stand in front of an electronic health record for more of their time, it’s easy to understand why our physical exam skills have diminished.

In this article, we are releasing the full collection of videos we recorded at our first annual Stanford 25 Skills Symposium hosted in September of 2015 at Stanford School of Medicine where we had clinical educators joins us from 13 countries and from all over the United States to share our methods of teaching the bedside exam.

Here, Dr. Abraham Verghese ask’s the question, “Why are we doing this teaching?” In it he shows a case of a patient with an abnormal jugular venous pulse. The diagnosis is apparent from observation of a trained eye. The counterargument might include the fact that this diagnosis would have been made on a bedside echo. We have a saying at Stanford: Tests aren’t ordered to make a diagnosis, they’re ordered to confirm your suspicion of one. Any clinician will tell you how no test is perfect. Much of medicine is game of probability. If a test is positive, it’s not always 100% positive, it’s for example, 92% positive (and that’s if you’re lucky). The goal of a good clinician is to obtain as much information as possible to tip the odds in your favor.

This is one of many reasons why we do this teaching. This is why the exam must not be forgotten.

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