Thoughts on bedside medicine
As a clinician educator and teacher of bedside medicine from the 1970s, I read with great interest Mollie Durkin's article in the February 2018 ACP Internist, “Bringing Medicine Back to the Bedside.” I could not agree more with the points made but offer a few additional comments.
First, many physical examination maneuvers (tests) have well-established sensitivities and specificities, as useful to the clinician as those for laboratory tests. Second, the practice of predicting what a laboratory test might demonstrate based on the bedside finding can be expanded to the teaching setting. Third, David L. Simel, MD, FACP, and colleagues initiated a series in JAMA decades ago on the rational clinical examination. He and Drummond Rennie, MD, MACP, have since published a primer on this subject. Their work can also serve as a resource. Fourth, bedside skills are ripe for research, not only in terms of determining operating characteristics of maneuvers but also in identifying meaningful teaching strategies and interventions. Finally, groups such as the Stanford Medicine 25 and Society of Bedside Medicine are on the cutting edge of this exciting discipline. I wish them well.
David A. Nardone, MD, FACP