They must complete four years of medical school of osteopathic school followed by several years of residency training in radiology.
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The cause of the oversights in the 208 responses was most often a failure to perform the physical examination at all - in 63 percent of the cases. Together with researchers from UCSF, Stanford and Tufts, we collected the incidents from responses to surveys sent to 5,000 physicians asking for first-hand stories of such medical errors. Verghese and I published a study in the American Journal of Medicine, which reports on a collection of 208 such occurrences and their consequences. In a first step toward creating a data-based measurement of medical errors due to inadequacies in the physical exam, Dr. Little has been done to quantify this type of medical error.
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Ioannidis: Physical examination inadequacies are a preventable source of medical error, and adverse events are caused mostly by failure to perform this relevant examination. I think of it as my worst nightmare, that a patient will slip through my grasp with a diagnosable or treatable condition. Verghese: Stories of shocking medical errors that occur because doctors miss something during a physical exam, or forget to examine a patient at all, are common. What are the consequences of lapses in the physical exams? It would be a shame for us to have reached this place where the only way we can make certain diagnoses is by ordering expensive and fancy tests when the diagnosis was really there all along for us to see. It reflects an increasing dependence on technology, and only paying lip service to the actual examination of the patient. Many of us recognized that there was a gap between what the medical record claimed was done on the patient, and the actual execution of the task. We often spend so much time with that entity in the computer, what I call the ‘iPatient, that the real patient in the bed is often left wondering, 'Where is everybody? What are they doing?' I sense that we’re spending very little time at the bedside. Verghese: The simple yet essential process of conducting the physical exam is "low hanging fruit." With the ascendance of technology there began to be less and less emphasis on what is obviously on the body that you can easily diagnose. What is the importance of the physical exam?
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Today, medical technologies are often a doctor’s first diagnostic tool. They used sight, touch, sound and smell to assess health and identify illness. Verghese: Physicians once relied on the five senses to diagnose patients. How has the physical exam changed in medicine?