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Physical Examination, Diagnostic Imaging, and Medical Errors

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Douglas W. Blayney, MD

My recent 2-week stint on the inpatient hematology teaching service led me to reflect on the importance of the physical examination. Most of us spent a lot of time in our own training learning to detect subtle heart murmurs and elusive spleens, to characterize breath sounds, and to ferret out disappearing axillary lymph nodes and subtle breast masses. In practice, I have found serial palpation of lymph node size and percussion of liver size and pleural effusions invariably useful; I always emphasize these techniques when I demonstrate physical examination to medical students and house officers.

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