https://en.wikipedia.org/wiki/Plain_meaning_rule
https://en.wikipedia.org/wiki/File:Graham%27s_Hierarchy_of_Disagreement-en.svg
https://en.wikipedia.org/wiki/Counterargument
http://www.duhaime.org/LegalDictionary/L/LiteralConstruction.aspx
http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=82
Inappropriate Imaging
http://www.consumerreports.org/cro/magazine/2012/06/many-common-medical-tests-and-treatments-are-unnecessary/index.htm
http://www.mayoclinic.org/tests-procedures/x-ray/basics/risks/prc-20009519
http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/default.htm
http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/ucm200086.htm
http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/default.htm
https://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/95xx/doc9567/07-17-healthcare_testimony.pdf
http://articles.chicagotribune.com/2012-04-04/news/ct-met-unnecessary-medicine-20120404_1_dialysis-patients-abim-foundation-patient-care
http://www.aaos.org/news/bulletin/janfeb07/clinical2.asp
https://www.colorado.gov/pacific/sites/default/files/Why%20is%20Health%20Care%20so%20expensive_%20-%20Consumer%20Reports.pdf
https://medicine.ucsf.edu/news/fom/frontiers.html?key=46&title="Choosing+Wisely"
https://www.cbo.gov/sites/default/files/presentation/44761-wharton0.pdf
http://www.workerscompzone.com/wp-content/uploads/2015/06/WorkersCompDr.Das6_.4.15.pdf
http://www.wcwebzine.com/magazine/issue3-5-14/GettingtoYESwithUR-IMR.pdf
http://www.coa.org/docs/2014annualmeeting/presentations/DasRupaliREVISED.pdf
http://www.dir.ca.gov/dwc/DWCPropRegs/MTUS_Regulations/MTUS_ChronicPainMedicalTreatmentGuidelines.pdf
https://dl.dropboxusercontent.com/u/83855124/MTUS.pdf
https://www.getmedlegal.com/SB899_Cust/MTUS.pdf
http://regs.cqstatetrack.com/info/get_text?action_id=731245&text_id=202800&type=full_text
https://www.dir.ca.gov/t8/ch4_5sb1a5_5_2.html
http://www.medscape.com/viewarticle/408063
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1395780/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1337855/pdf/cmaj00070-0025.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1395780/
http://ebm.bmj.com/content/5/5/132.full
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1878168/pdf/jcgprac00013-0081.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1878168/?page=1
J Coll Gen Pract. 1963 Nov; 6(4): 579–589.
PMCID: PMC1878168
Diagnostic Process
D. L. Crombie
Copyright and License information ►
http://ebm.bmj.com/content/5/5/132.full#ref-1
http://ebm.bmj.com/content/5/5/132.full
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1395780/
http://www.medscape.com/viewarticle/480241
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1002356/pdf/westjmed00116-0039.pdf
http://www.ncbi.nlm.nih.gov/pubmed/2190412/
http://www.ncbi.nlm.nih.gov/pubmed/3675097/
AbstractSend to:
Arch Intern Med. 1987 Nov;147(11):1957-60.
The diagnostic value of the medical history. Perceptions of internal medicine physicians.
Rich EC1, Crowson TW, Harris IB.
Author information
Abstract
We investigated the perceptions of 71 internal medicine faculty and residents regarding the diagnostic value of the medical history and other attitudes toward the medical interview. Physicians perceive the medical history as having much higher value in diagnosis than either the physical examination or laboratory/radiography information (mean scores, 5.76, 2.41, and 2.49, respectively). The perceptions of the importance of the physician-patient relationship were significantly correlated with the diagnostic value of the history. There was also a strong relationship between the perceived value of the history and preferences for more skilled interviewing responses, as measured by the Helping Relationship Inventory. Contrary to expectations, the perceptions of residents toward the diagnostic value of the patient's history increased significantly over the course of training (5.00 to 6.00). We conclude that despite the increasing emphasis on diagnostic technology, internal medicine residents and faculty continue to view the patient's history as the preeminent source of diagnostic information. Physician attitudes toward the physician-patient relationship and toward the medical interview may contribute to the diagnostic value of the history.
PMID: 3675097 [PubMed - indexed for MEDLINE]
http://archinte.jamanetwork.com/article.aspx
http://www.helpingyoucare.com/14704/study-finds-medical-history-key-to-correct-diagnosis
http://patient.info/doctor/history-and-physical-examination
It is said that over 80% of diagnoses are made on history alone, a further 5-10% on examination and the remainder on investigation.[1]
http://www.ijme.net/archive/3/diagnosis-by-medical-students.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1673456/
http://www.medscape.com/viewarticle/480241_4
diagnosis 80% history
http://medicaltextbooksrevealed.s3.amazonaws.com/files/17036-53.pdf
http://fortune.com/2012/12/04/technology-will-replace-80-of-what-doctors-do/
http://www.ncbi.nlm.nih.gov/pubmed/18075958
http://www.amdtelemedicine.com/blog/article/telemedicine-huge-ally-military-clinics
http://www.americantelemed.org/news-landing/2014/01/07/telemedicine-coverage-extended-for-military-to-civilian-transitions#.Vi3rMdrVnx4
Recently signed into law, the 2014 National Defense Authorization Act expands health care coverage through telemedicine for military members transitioning to civilian life.
Service members and their families previously received 180 days of healthcare coverage during the transition from military to civilian life through what is known as the Transitional Assistance Management Program. Rep. Glenn Thompson (R-PA) included a provision to the bill which extends coverage by 180 more days for all services rendered through telemedicine. The provision’s primary intent is to serve individuals with post-traumatic stress, which often does not present symptoms within 6 months.
Rep. Thompson was successful two years ago in allowing individuals needing U.S Department of Defense Department healthcare to be treated by any health professional licensed in any state, and is now the lead Republican on H.R. 2001 to do the same for veterans’ interstate health care.
http://armymedicine.mil/Pages/telehealth.aspx
http://www.fiercehealthit.com/story/bill-expanded-military-telemedicine-coverage-passed/2014-01-03
A bill to expand telemedicine coverage for members of the military was passed as part of the 2014 National Defense Authorization Act, which President Obama signed last week.
Under the Transitional Assistance Management Program (TAMP), service members transitioning into civilian life receive 180 days of health insurance coverage. The new bill would cover an additional 180 days for health services provided through telemedicine.
http://www.mbc.ca.gov/Licensees/Telehealth.aspx
Telehealth (previously called telemedicine) is seen as a tool in medical practice, not a separate form of medicine. There are no legal prohibitions to using technology in the practice of medicine, as long as the practice is done by a California licensed physician. Telehealth is not a telephone conversation, email/instant messaging conversation, or fax; it typically involves the application of videoconferencing or store and forward technology to provide or support health care delivery.
The standard of care is the same whether the patient is seen in-person, through telehealth or other methods of electronically enabled health care. Physicians need not reside in California, as long as they have a valid, current California license.
https://meded.ucsd.edu/clinicalmed/history.htm
http://getbetterhealth.com/patient-history-found-to-be-key-element-in-making-a-diagnosis/2011.08.28
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345897/
http://patient.info/doctor/history-taking#ref-3
Migraine
http://patient.info/doctor/history-and-physical-examination#ref-1
diagnosis history alone
________________________
http://www.amazon.com/dp/0723434549/ref=wl_it_dp_o_pC_S_ttl?_encoding=UTF8&colid=3MLIJU48MFY6B&coliid=I3G6V8RKAAI1XN
Clinical Examination:
With STUDENT CONSULT Access
4th Edition
by Owen Epstein MB BCh FRCP (Author), G. David Perkin BA MB FRCP
BA MB FRCP (Author), John Cookson MD FRCP (Author), Ian S. Watt BSc MB ChB MPH FFPH (Author), Roby Rakhit BSc MD FRCP (Author), Andrew W. Robins MB MSc MRCP FRCHCH (Author), Graham A. W. Hornett BA MA MB BChir FRCGP (Author)
Publisher: Mosby; 4 edition (July 10, 2008)
ISBN-10: 0723434549
ISBN-13: 978-0723434542
_____________________
https://www.elsevier.com/books/clinical-examination/epstein/978-0-7234-3454-2
http://www.us.elsevierhealth.com/product.jsp?isbn=9780723434542&sgCountry=US&isbn=9780723434542
http://www.us.elsevierhealth.com/us/product/toc.jsp?isbn=9780723434542
http://www.us.elsevierhealth.com/media/us/samplechapters/9780723434542/9780723434542.pdf
Clinical Examination
With STUDENT CONSULT Access
By
Owen Epstein, MB, BCh, FRCP, Consultant Physician and Gastroenterologist, Royal Free Hospital NHS Trust, London, UK
G. Perkin, BA, MB, FRCP BA, MB, FRCP, Consultant Neurologist, Charing Cross and HIllingdon Hospitals, London, UK Emeritus Consultant Neurologist, Charing Cross and HIllingdon Hospitals, London, UK
John Cookson, MD, FRCP, Dean of the Undergraduate School, Hull and York Medical School, University of York, York, UK
Ian Watt, BSc, MB, ChB, MPH, FFPH, Professor of Primary Care, Hull and York Medical School, University of York, York, UK
Roby Rakhit, BSc, MD, FRCP, Consultant Cardiologist and Honorary Senior Lecturer, Royal Free Hospital, London, UK
Andrew Robins, MB, MSc, MRCP, FRCHCH, Consultant Paediatrician, Whittington Hospital NHS Trust, London UK
Graham Hornett, BA, MA, MB, BChir, FRCGP, General Practitioner, Specialist in ENT, Surrey Primary Care Trust, Guildford, Surrey, UK
The fourth edition of Clinical Examination provides a clear, practical and above all, superbly illustrated guide to all aspects of history taking and patient examination. Designed to be accessible both to medical students just starting their clinical attachments and to more experienced readers, the clear writing style, the innovative use of clinical photographs and the explanatory illustrations combine to explain and clarify the concepts and skills necessary to take a history and perform an examination. The text is organised by body system, with each chapter structured the same way: firstly, underlying structure and function; secondly, signs, symptoms and abnormalities; thirdly, patient examination.
Audience
Medical students, junior doctors, primary care physicians / physician assistants, general practitioners
Published: June 2008
Imprint: MOSBY
ISBN: 978-0-7234-3454-2
_____________________
http://cdnmedhall.org/inductees/sir-william-osler
http://www.oslersymposia.org/about-Sir-William-Osler.html
Sir William Osler, M.D., C.M., 1st Baronet (July 12, 1849 – December 29, 1919) was a Canadian physician. (The "o" in "Osler" is pronounced like the "o" in "go".) He was one of the "Big Four" founding professors at Johns Hopkins Hospital as the first Professor of Medicine and founder of the Medical Service there. (The "Big Four" were William Osler, Professor of Medicine; William Stewart Halsted, Professor of Surgery; Howard A. Kelly, Professor of Gynecology; and William H. Welch, Professor of Pathology.) Osler created the first residency program for specialty training of physicians, and he was the first to bring medical students out of the lecture hall for bedside clinical training.
He has been called the "Father of modern medicine." Osler was a pathologist, physician, educator, bibliophile, historian, author, and renowned practical joker.
He liked to say, "He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all." His best-known saying was "Listen to your patient, he is telling you the diagnosis," which emphasizes the importance of taking a good history.
https://en.wikipedia.org/wiki/William_Osler
https://en.wikipedia.org/wiki/William_Osler
He liked to say, "He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all."[citation needed] His best-known saying was "Listen to your patient, he is telling you the diagnosis," which emphasises the importance of taking a good history.[2]
http://www.bmj.com/content/321/7268/1087.2/rr/760724
Osler fundamentally altered the process of medical education by displacing students from the lecture theatre onto the wards. It was a radical move since the firmly entrenched belief was that incubatory physicians should nest in libraries and learn medicine through long hours of book-work. With the radiance of the natural teacher, Osler’s mellifluous voice could be heard at a clinical bedside where he would never admonish but would always entertainingly educate. Even the student who had turned cheerless from aggravations at the hands of another teacher would respond to the style of Professor Osler who with a friendliness would whisper over a shoulder, “Just listen to your patient, he is telling you the diagnosis.” By emphasising the centrality of history-taking and the examination of patients, Osler compressed the course of undergraduate and postgraduate development. Physicians would no longer embark on a haphazard journey of discovery but would acquire clinical method at the beginning of their vocation. Outside of the junior ranks, he was knowingly and selectively appreciative of contemporaries such as William Gowers whom he called “that brilliant ornament of British medicine,” a physician assessed as the most piercingly talented neurologist of all time.
http://ukcatalogue.oup.com/product/9780195329605.do
https://books.google.com/books?id=Vl5iC4qZkrcC&pg=PT99&lpg=PT99&dq=osler+william+listen+patient+diagnosis&source=bl&ots=Tfu7n5f1AA&sig=gb1M3iy7jpb-jSthv79vxU5tSfk&hl=en&sa=X&ved=0CD4Q6AEwBTgKahUKEwihgoDhyeTIAhVElogKHaT0C0A#v=onepage&q=osler%20william%20listen%20patient%20diagnosis&f=false
The Quotable Osler 1st Edition
http://www.amazon.com/Quotable-Osler-Mark-Silverman/dp/1934465003/ref=mt_paperback?_encoding=UTF8&me=
http://www.jchimp.net/index.php/jchimp/article/viewFile/8428/pdf
http://emedsa.org.au/Students/Maxims.htm
http://www.scmsociety.com/pearls/2009/10/sir-william-osler-md-.html
http://hlwiki.slais.ubc.ca/index.php/William_Osler
https://store.acponline.org/ebizatpro/images/ProductImages/books/toc/The%20Quotable%20Osler%20Revised%20Paper%20Back%20Ed%20TOC-Front%20Matter.pdf
http://scholarlycommons.law.hofstra.edu/cgi/viewcontent.cgi?article=1314&context=faculty_scholarship
156
Learn the Art of Observation
“The whole art of medicine is in observation… but to educate the eye to see, the ear to hear and the finger to feel takes time, and to make a beginning, to start a man on the right path, is all that you can do.”
– Wiliam Osler
http://annals.org/article.aspx?articleid=705524
http://annals.org/article.aspx?articleid=705524
Sir William Osler took as his teaching motto the ancient maxim that the "whole art of medicine is in observation" (1). Rufus Cole (2) describes how Oslputer put that precept into action and made the experience vivid for his students:Osler's greatest originality as a teacher was shown in his work with students who for the first time were coming into contact with patients. He taught them by joining in the examination of patients chosen at random whom neither he nor the students had ever seen before. With no other aids, teacher and students attempted to learn all they could...
http://www.medscape.com/viewarticle/444905
Richard E. Verney[15] uses Osler's statement from The Student Life, "The whole art of medicine is observation, as the old motto goes,
Verney RE: The Student Life: The Philosophy of Sir William Osler. London, E & S Livingstone, 1957
https://books.google.com/books?id=zHrHS8INSxoC&pg=PA111&lpg=PA111&dq=osler+observation&source=bl&ots=bDleI9zW3F&sig=RV3zK9qyL9URgsQlo8OXrO_Omqg&hl=en&sa=X&ved=0CFIQ6AEwB2oVChMI-fyWwNDkyAIVCsdjCh3yvQpA#v=onepage&q=osler%20observation&f=false
Osler: Inspirations from a Great Physician
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009009.pub2/abstract
http://jonbarron.org/natural-health/annual-physical-exam-benefits#footnote1_hc5n75j
http://jonbarron.org/natural-health/annual-physical-exam-benefits#footnote1_hc5n75j
http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=physical
http://www.nytimes.com/2015/01/09/opinion/skip-your-annual-physical.html?_r=0
http://www.blisstree.com/2012/10/17/sex-relationships/yearly-physical-exam-checkup-unnecessary-690/
Dr. Doug Campos-Outcalt Arizona physical exam meaningless
Read more: http://www.blisstree.com/2012/10/17/sex-relationships/yearly-physical-exam-checkup-unnecessary-690/#ixzz3pqUr5c85
http://www.livescience.com/36692-yearly-physical-healthy-people-benefit.html
http://www.cpw-law.com/2013/01/annual-physical-meaningless-for-healthy-people/
http://www.doctorbob.com/news/5_13calltoabandon.html
http://archive.azcentral.com/healthyliving/articles/20140212study-questions-need-annual-mammograms.html
http://www.doctorbob.com/news/5_13calltoabandon.html
_____________________
http://www.helpingyoucare.com/14704/study-finds-medical-history-key-to-correct-diagnosis
_________________________________
Invited Commentary—Medical Technology—Still an Adjunct to Clinical Skills in Making a Diagnosis FREE
Melvin D. Cheitlin, MD
http://archinte.jamanetwork.com/article.aspx?articleid=1105870
< Previous ArticleNext Article >
Research Letters | Aug 8 2011
Invited Commentary—Medical Technology—Still an Adjunct to Clinical Skills in Making a Diagnosis FREE
Melvin D. Cheitlin, MD
[-] Author Affiliations
Author Affiliation: Department of Medicine (Emeritus Professor of Medicine), University of California, San Francisco.
Arch Intern Med. 2011;171(15):1394-1400. doi:10.1001/archinternmed.2011.339.
_____________
http://www.ncbi.nlm.nih.gov/pubmed/1148666
Br Med J. 1975 May 31;2(5969):486-9.
Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients.
Hampton JR, Harrison MJ, Mitchell JR, Prichard JS, Seymour C.
Abstract
To evaluate the relative importance of the medical history, the physical examination, and laboratory investigations in the diagnosis and management of medical outpatients some physicians recorded their diagnosis and a prediction of the method of managementafter reading the patient's referral letter, again after taking the history, and againafter performing the physical examination. These diagnoses and predictions were compared with the diagnosis and method of management which had been adopted two months after the patient's initial attendance. A diagnosis that agreed with the one finally accepted was made after reading the referral letter and taking the history in 66 out of 80 new patients; the physical examination was useful in only seven patients, and the laboratory investigations in a further seven. In only one of six patients in whom the physician was unable to make any diagnosis after taking the history and examining the patient did laboratory investigations lead to a positive diagnosis.
PMID: 1148666 [PubMed - indexed for MEDLINE] PMCID: PMC1673456 Free PMC Article
__________________
http://www.bmj.com/content/2/5969/486
Research Article
Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients.
Br Med J 1975; 2 doi: http://dx.doi.org/10.1136/bmj.2.5969.486 (Published 31 May 1975)
Cite this as: Br Med J 1975;2:486
Article
Related content
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J R Hampton, M J Harrison, J R Mitchell, J S Prichard, C Seymour
Abstract
To evaluate the relative importance of the medical history, the physical examination, and laboratory investigations in the diagnosis and management of medical outpatients some physicians recorded their diagnosis and a prediction of the method of managementafter reading the patient's referral letter, again after taking the history, and againafter performing the physical examination. These diagnoses and predictions were compared with the diagnosis and method of management which had been adopted two months after the patient's initial attendance. A diagnosis that agreed with the one finally accepted was made after reading the referral letter and taking the history in 66 out of 80 new patients; the physical examination was useful in only seven patients, and the laboratory investigations in a further seven. In only one of six patients in whom the physician was unable to make any diagnosis after taking the history and examining the patient did laboratory investigations lead to a positive diagnosis.
___________
http://www.ncbi.nlm.nih.gov/pubmed/1536065
West J Med. 1992 Feb;156(2):163-5.
Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses.
Peterson MC1, Holbrook JH, Von Hales D, Smith NL, Staker LV.
Author information
Abstract
We report an attempt to quantitate the relative contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. In this prospective study of 80 medical outpatients with new or previously undiagnosed conditions, internists were asked to list their differential diagnoses and to estimate their confidence in each diagnostic possibility after the history, after the physical examination, and after the laboratory investigation. In 61 patients (76%), the history led to the final diagnosis. The physical examination led to the diagnosis in 10 patients (12%), and the laboratory investigation led to the diagnosis in 9 patients (11%). The internists' confidence in the correct diagnosis increased from 7.1 on a scale of 1 to 10 after the history to 8.2 after the physical examination and 9.3 after the laboratory investigation. These data support the concept that most diagnoses are made from the medical history. The results of physical examination and the laboratory investigation led to fewer diagnoses, but they were instrumental in excluding certain diagnostic possibilities and in increasing the physicians' confidence in their diagnoses.
PMID: 1536065 [PubMed - indexed for MEDLINE] PMCID: PMC1003190 Free PMC Article
______________
http://www.ncbi.nlm.nih.gov/pubmed/11273467
AbstractSend to:
J Assoc Physicians India. 2000 Aug;48(8):771-5.
A study on relative contributions of the history, physical examination and investigations in making medical diagnosis.
Roshan M1, Rao AP.
Author information
Abstract
Here we report an attempt to quantitate the relative contributions of the history, physical examination and investigations in making medical diagnosis. In this prospective study of 100 patients, with new or previously undiagnosed conditions, we listed their differential diagnosis with confidence score; after the history, after physical examination and after the investigations. In two patients no definite final diagnoses could be arrived even after extensive investigation--these two cases were excluded from the study. In seventy seven patients (78.58%) patients, the history led to diagnosis. The physical examination led to diagnosis in eight patients (8.17%); and investigations led to diagnosis in 13 patients (13.27%). The confidence in correct diagnosis increased from 6.36 on a scale of one to ten after the history to 7.57 after physical examination and 9.84 after investigations--implying that history, physical examination and investigation have their own limitation at each stage and an integrative approach is needed in making a medical diagnosis with more emphasis on history.
Comment in
Relevance of history and clinical examination in medical practice. [J Assoc Physicians India. 2001]
_______________
http://archinte.jamanetwork.com/article.aspx?articleid=1106285
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August 8/22, 2011, Vol 171, No. 15 >
< Previous ArticleNext Article >
Research Letters | Aug 8 2011
Utility of Clinical Examination in the Diagnosis of Emergency Department Patients Admitted to the Department of Medicine of an Academic Hospital FREE
Liza Paley, MD; Taiba Zornitzki, MD; Joel Cohen, MD; Joshua Friedman, MD; Natalia Kozak, MD; Ami Schattner, MD
[+] Author Affiliations
Arch Intern Med. 2011;171(15):1393-1400. doi:10.1001/archinternmed.2011.340.
___________________
http://www.helpingyoucare.com/14704/study-finds-medical-history-key-to-correct-diagnosis
Study Finds Medical History Key to Correct Diagnosis
By Editor, On August 12th, 2011
Doctor with Patient Reviewing Medical HistoryA new study published in the Archives of Internal Medicine, a journal of the American Medical Association, found that patients’ medical history “emerged as the key element in formulating correct diagnosis” of medical conditions.
___________________
______________________
http://www.ncbi.nlm.nih.gov/pubmed/1536065
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1003190/
AbstractSend to:
West J Med. 1992 Feb;156(2):163-5.
Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses.
Peterson MC1, Holbrook JH, Von Hales D, Smith NL, Staker LV.
Author information
Abstract
We report an attempt to quantitate the relative contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. In this prospective study of 80 medical outpatients with new or previously undiagnosed conditions, internists were asked to list their differential diagnoses and to estimate their confidence in each diagnostic possibility after the history, after the physical examination, and after the laboratory investigation. In 61 patients (76%), the history led to the final diagnosis. The physical examination led to the diagnosis in 10 patients (12%), and the laboratory investigation led to the diagnosis in 9 patients (11%). The internists' confidence in the correct diagnosis increased from 7.1 on a scale of 1 to 10 after the history to 8.2 after the physical examination and 9.3 after the laboratory investigation. These data support the concept that most diagnoses are made from the medical history. The results of physical examination and the laboratory investigation led to fewer diagnoses, but they were instrumental in excluding certain diagnostic possibilities and in increasing the physicians' confidence in their diagnoses.
PMID: 1536065 [PubMed - indexed for MEDLINE] PMCID: PMC1003190 Free PMC Article
______________________
http://www.ncbi.nlm.nih.gov/pubmed/11273467
AbstractSend to:
J Assoc Physicians India. 2000 Aug;48(8):771-5.
A study on relative contributions of the history, physical examination and investigations in making medical diagnosis.
Roshan M1, Rao AP.
Author information
Abstract
Here we report an attempt to quantitate the relative contributions of the history, physical examination and investigations in making medical diagnosis. In this prospective study of 100 patients, with new or previously undiagnosed conditions, we listed their differential diagnosis with confidence score; after the history, after physical examination and after the investigations. In two patients no definite final diagnoses could be arrived even after extensive investigation--these two cases were excluded from the study. In seventy seven patients (78.58%) patients, the history led to diagnosis. The physical examination led to diagnosis in eight patients (8.17%); and investigations led to diagnosis in 13 patients (13.27%). The confidence in correct diagnosis increased from 6.36 on a scale of one to ten after the history to 7.57 after physical examination and 9.84 after investigations--implying that history, physical examination and investigation have their own limitation at each stage and an integrative approach is needed in making a medical diagnosis with more emphasis on history.
Comment in
Relevance of history and clinical examination in medical practice. [J Assoc Physicians India. 2001]
PMID: 11273467 [PubMed - indexed for MEDLINE]
________________
http://www.ncbi.nlm.nih.gov/pubmed/466256
AbstractSend to:
Br Med J. 1979 Jul 7;2(6181):21-4.
Costs of unnecessary tests.
Sandler G.
Abstract
The relative importance of the history, examination, and routine and special investigations has been assessed in the diagnosis and management of 630 medical outpatients. The history was the most important factor in both diagnosis and management in cardiovascular, neurological, respiratory, urinary, and other miscellaneous problems, and decided 56% of all diagnoses and 46% of all management. Examination findings were of more limited value, accounting for only 17% of diagnostic and 17% of management decisions overall. Routine haematology and urine examinations were of minimal value, contributing to less than 1% of all diagnoses. Special investigations decided most of the diagnoses and management in alimentary and endocrine problems, but were less helpful in problems affecting all other systems. If a local survey in the Trent Region reflected the pattern of medical outpatient practice nationally, then pounds 1.25 million could be saved annually if routine investigation was discontinued on all patients whose problem had already been diagnosed on the basis of the history and the clinical examination.
PMID: 466256 [PubMed - indexed for MEDLINE] PMCID: PMC1595755 Free PMC Article
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595755/
__________________
http://www.ncbi.nlm.nih.gov/pubmed/12699858
http://www.pedneur.com/article/S0887-8994(02)00494-0/abstract
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Pediatr Neurol. 2003 Feb;28(2):96-9.
The utility of the physical examination and investigations in the pediatricneurology consultation.
Dooley JM1, Gordon KE, Wood EP, Camfield CS, Camfield PR.
Author information
Abstract
For most consultations the diagnosis is established by a thorough clinical history. We prospectively assessed the impact of each component of the pediatric neurologic consultation in 500 consecutive referrals to a tertiary care pediatric neurology clinic. Diagnosis and management decisions were declared for each patient by the consultant after each stage of the consultation process (1: receipt of consultation letter, 2: history, 3: physical examination and 4: receipt of investigation results). We found that the physical examination and investigations influenced management decisions for less than 6%. Specifically the examination was never influential for children with headaches, Tourette syndrome, developmental delay or attention-deficit-hyperactivity disorder (ADHD). Investigations never influenced management for those with Tourette syndrome, ADHD, or cerebral palsy. Therefore for the majority of children the critical component of the pediatric neurology consultation is a detailed clinical history.
PMID: 12699858 [PubMed - indexed for MEDLINE]
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http://www.ncbi.nlm.nih.gov/pubmed/3675097
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Arch Intern Med. 1987 Nov;147(11):1957-60.
The diagnostic value of the medical history. Perceptions of internal medicine physicians.
Rich EC1, Crowson TW, Harris IB.
Author information
Abstract
We investigated the perceptions of 71 internal medicine faculty and residents regarding the diagnostic value of the medical history and other attitudes toward the medical interview. Physicians perceive the medical history as having much higher value in diagnosis than either the physical examination or laboratory/radiography information (mean scores, 5.76, 2.41, and 2.49, respectively). The perceptions of the importance of the physician-patient relationship were significantly correlated with the diagnostic value of the history. There was also a strong relationship between the perceived value of the history and preferences for more skilled interviewing responses, as measured by the Helping Relationship Inventory. Contrary to expectations, the perceptions of residents toward the diagnostic value of the patient's history increased significantly over the course of training (5.00 to 6.00). We conclude that despite the increasing emphasis on diagnostic technology, internal medicine residents and faculty continue to view the patient's history as the preeminent source of diagnostic information. Physician attitudes toward the physician-patient relationship and toward the medical interview may contribute to the diagnostic value of the history.
PMID: 3675097 [PubMed - indexed for MEDLINE]
http://archinte.jamanetwork.com/article.aspx?articleid=609047
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http://www.ncbi.nlm.nih.gov/pubmed/21824958
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Arch Intern Med. 2011 Aug 8;171(15):1396. doi: 10.1001/archinte.171.15.1396-a.
The value of history taking in diagnosis: comment on "Utility of clinical examination in the diagnosis of emergency department patients admitted to the department of medicine of an academic hospital".
Redberg RF.
Comment on
Utility of clinical examination in the diagnosis of emergency department patients admitted to the department of medicine of an academic hospital. [Arch Intern Med. 2011]
PMID: 21824958 [PubMed - indexed for MEDLINE]
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http://archinte.jamanetwork.com/article.aspx?articleid=1106286
ugust 8/22, 2011, Vol 171, No. 15 >
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Research Letters | Aug 8 2011
Editor's Note—The Value of History Taking in Diagnosis FREE
Rita F. Redberg, MD, MSc
Arch Intern Med. 2011;171(15):1394-1400. doi:10.1001/archinte.171.15.1396-a. Text Size: A A A
Article
Correspondence (1)
Comments
The research letter by Paley et al reminds us of the value of lower-tech ways of making a diagnosis of patients seen in the emergency department (ED), as technology increases in availability and complexity and because ED health professionals now routinely order imaging tests, not uncommonly without even examining patients. The authors found that patient history was the key element in formulating a correct diagnosis and, along with physical examination and basic tests, established most diagnoses.
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http://archinte.jamanetwork.com/article.aspx?articleid=1106286
< Previous ArticleNext Article >
Research Letters | Aug 8 2011
Editor's Note—The Value of History Taking in Diagnosis FREE
Rita F. Redberg, MD, MSc
Arch Intern Med. 2011;171(15):1394-1400. doi:10.1001/archinte.171.15.1396-a.
August 8/22, 2011, Vol 171, No. 15 >
< Previous ArticleNext Article >
Research Letters | Aug 8 2011
Editor's Note—The Value of History Taking in Diagnosis FREE
Rita F. Redberg, MD, MSc
Arch Intern Med. 2011;171(15):1394-1400. doi:10.1001/archinte.171.15.1396-a. Text Size: A A A
Article
Correspondence (1)
Comments
The research letter by Paley et al reminds us of the value of lower-tech ways of making a diagnosis of patients seen in the emergency department (ED), as technology increases in availability and complexity and because ED health professionals now routinely order imaging tests, not uncommonly without even examining patients. The authors found that patient history was the key element in formulating a correct diagnosis and, along with physical examination and basic tests, established most diagnoses.
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http://www.ncbi.nlm.nih.gov/pubmed/21824957
http://archinte.jamanetwork.com/article.aspx?articleid=1105870
Invited Commentary—Medical Technology—Still an Adjunct to Clinical Skills in Making a Diagnosis FREE
Melvin D. Cheitlin, MD
[+] Author Affiliations
Arch Intern Med. 2011;171(15):1394-1400. doi:10.1001/archinternmed.2011.339.
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http://www.melbourneorthopaedicspecialists.com.au/patient_assessment.html
It is said that over 80% of diagnoses are made on history alone, a further 5-10% on examination and the remainder on investigation.
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http://www.jcda.ca/article/e45
It has been estimated that over 80% of clinical diagnoses are based on history alone. A further 5–10% are based on clinical examination and the remainder on investigations and special tests. 2,3
As such, to diagnose and treat patients successfully, practitioners must conduct a comprehensive examination before ordering further investigations.
References
Epstein O, Perkin GD, Cookson J, et al. Consultation, medical history and record taking. In Clinical Examination. 4th ed. Maryland Heights, Mo.: Mosby Elsevier Ltd.; 2008. p. 1-19.
Epstein O, Perkin GD, Cookson J, et al. The general examination. In Clinical Examination. 4th ed. Maryland Heights, Mo.: Mosby Elsevier Ltd.; 2008. p. 1-19.
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http://www.ijme.net/archive/3/diagnosis-by-medical-students.pdf
medical history
japan
english article
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https://meded.ucsd.edu/clinicalmed/history.htm
A Practical Guide to Clinical Medicine
A comprehensive physical examination and clinical education site for medical students and other health care professionals
Web Site Design by Jan Thompson, Program Representative, UCSD School of Medicine.
Content and Photographs by Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California 92093-0611.
Send Comments to: Charlie Goldberg, M.D.
Obtaining an accurate history is the critical first step in determining the etiology of a patient's problem. A large percentage of the time, you will actually be able to make a diagnosis based on the history alone. The value of the history, of course, will depend on your ability to elicit relevant information.
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http://accessmedicine.mhmedical.com/content.aspx?bookid=500§ionid=41026543
Chapter 1. History and Physical Examination: Art and Science
The medical history, say venerable clinicians righteously, is the core art of patient care. They continue to cite references that maintain that the patient's history provides the diagnosis in 85% of cases.
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http://scholarlycommons.law.hofstra.edu/cgi/viewcontent.cgi?article=1314&context=faculty_scholarship
http://www.jchimp.net/index.php/jchimp/article/viewFile/8428/pdf
http://annals.org/article.aspx?articleid=705524
https://www.sciencebasedmedicine.org/re-thinking-the-annual-physical/
http://discovermagazine.com/2013/april/7-annual-checkups-are-a-waste-of-time
_____________
http://www.ncbi.nlm.nih.gov/pubmed/23169871
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BMJ. 2012 Nov 20;345:e7775. doi: 10.1136/bmj.e7775.
The value of conducting periodic health checks.
MacAuley D.
Comment on
General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. [BMJ. 2012]
PMID: 23169871 [PubMed - indexed for MEDLINE]
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Publication Types, MeSH Terms
http://www.bmj.com/content/345/bmj.e7775.long
The value of conducting periodic health checks
BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7775 (Published 20 November 2012)
Cite this as: BMJ 2012;345:e7775
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CCBYNC Open access
Research
General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis
BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7191 (Published 20 November 2012)
Cite this as: BMJ 2012;345:e7191
Article
Related content
Metrics
Responses
Peer review
Lasse T Krogsbøll, doctor, Karsten Juhl Jørgensen, doctor, Christian Grønhøj Larsen, doctor, Peter C Gøtzsche, professor, director
Author affiliations
Correspondence to: L T Krogsbøll ltk@cochrane.dk
http://www.bmj.com/content/345/bmj.e7191
http://www.medscape.com/viewarticle/444905
The practice of medicine is an art, based on science.
http://www.uspreventiveservicestaskforce.org/Page/Name/recommendations
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3781254/
Survey of inappropriate use of magnetic resonance imaging
http://www.consumerreports.org/cro/magazine/2012/06/many-common-medical-tests-and-treatments-are-unnecessary/index.htm
Many common medical tests and treatments are unnecessary
Learn when to say ‘Whoa!’ to your doctor
Consumer Reports magazine: June 2012
Doctors often order tests and recommend drugs or procedures when they shouldn’t—sometimes even when they know they shouldn’t. In fact, nearly half of primary-care physicians say their own patients get too much medical care, according to a survey published in 2011 by researchers at Dartmouth College. And the Congressional Budget Office says that up to 30 percent of the health care in the U.S. is unnecessary.
All that unneeded care can be hazardous to your health—and your wallet. For example, X-rays and CT scans expose you to potentially cancer-causing radiation, and can lead to follow-up tests and treatment with additional risks. And the costs can be substantial. A 2011 study found that the price tag for 12 commonly overused tests, such as annual electrocardiograms (EKGs) for heart disease and imaging tests for lower-back pain, was about $6.8 billion.
The problem has become so serious that such groups as the American College of Physicians, the ABIM Foundation, the National Physicians Alliance, and a coalition of medical societies in a project called Choosing Wisely have compiled lists of tests and treatment doctors themselves say are done too often. Below are our top five examples culled from those lists. (For more information, read Choosing Wisely: How to avoid unnecessary tests and treatments.)
Good Ones
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1003190/
http://www.ncbi.nlm.nih.gov/pubmed/3218864
Sir William Osler
"The Father of Modern Medicine"
Father of Modern Medicine
founding professor of Johns Hopkins School of Medicine
first Physician-in-Chief of the new Johns Hopkins Hospital
Regius Professor of Medicine at Oxford
1911, was knighted for his contributions to the field of medicine.
knighted in 1911 in recognition of his contributions to medical science and teaching.
http://profiles.nlm.nih.gov/ps/retrieve/Narrative/GF/p-nid/363
http://www.hopkinsmedicine.org/about/history/history5.html
http://sirosler.weebly.com
“The practice of medicine is an art, not a trade; a calling, not a business; a
calling in which your heart will be exercised equally with your head.”
Sir William Osler - July 12, 1849 to December 29, 1919
http://www.britannica.com/biography/Sir-William-Osler-Baronet
http://www.encyclopedia.com/topic/Sir_William_Osler.aspx
https://osler-letters.library.mcgill.ca/about
http://www.ncbi.nlm.nih.gov/pubmed/20430933
http://www.ncbi.nlm.nih.gov/pubmed/20423575
face-to-face and telephone consultations
http://www.ncbi.nlm.nih.gov/pubmed/25932684
Texas courts
Teladoc argues that a face-to-face meeting is unnecessary for new patients.
physician who has seen a patient in person to interact
https://www.teladoc.com/news/2015/05/29/federal-court-rules-in-favor-of-teladoc/
http://www.teladoc.com
http://www.texmed.org/Template.aspx?id=33123
http://www.texastribune.org/2015/05/30/teladoc-scores-early-victory-against-medical-board/
http://www.npr.org/sections/health-shots/2015/06/02/408513139/texas-put-brakes-on-telemedicine-and-teladoc-cries-foul
http://theweek.com/articles/447611/why-telemedicine-future-health-care-industry
TeleMedicine
http://www.keplerhealthlaw.com/uploads/3/4/1/4/3414608/chln_telemedicine_article.pdf
BUSINESS AND PROFESSIONS CODE
SECTION 2220-2319
2290.5
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