UMKC Case Highlights the Importance of a Thorough Physical Exam

A recent case presented by the Department of Internal Medicine at the University of Missouri Kansas City (UMKC) demonstrates the importance of physical exam skills and provides a clear example that lack of thorough history and complete physical exam can lead to diagnostic errors.

The case involves a 28-year-old male patient who arrived at the emergency department with sudden onset left facial paralysis. The patient had a history of substance abuse. The patient’s initial diagnosis was Bell’s palsy, and he was given oral steroids and discharged.

However, the patient returned the next day, and his condition had worsened. The patient was admitted and evaluated. More information was gained about his medical history including daily intravenous heroin injections. A thorough physical examination revealed an error in the original diagnosis. This led to evaluation by neurology and cardiology teams. It was determined that the patient had extensive acute embolic strokes secondary to infective endocarditis. From there, life-saving treatments were implemented.

In their discussion, the authors of the article (which was published in Cureus) emphasize the importance of the physical exam for proper diagnosis of patients. Through their findings, we see a direct example of how poor physical examination skills can lead to diagnostic errors and can, in turn, pose a threat to patient safety. Furthermore, the authors emphasize the importance of physicians teaching these skills to medical students and residents.

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