In your message dated Friday 12, July 1996 Trefor wrote :
> Are you saying that history and simple physical examination are all
one needs
> and the intimate examination is irrelevant tothe decision to refer?
I would
> agree with a comment on this thread that the result of the VE/PR in
acute
> abdominal pain is not going to influence management, if there is a
chance
> that it is an ectopic pregnancy, I would'nt do a VE to find out, if
the
> choice is between appendix and pelvic inflammatory disease then the
appendix
> wins (i.e. off to the surgeons and let them decide).
>
> A question;
>
> Intimate examinations in acute abdominal pain are the remit of
secondary
> care, if it's not acute then a chaparone can be arranged - discuss
I've followed this thread with a lot of interest. It really boils down
to how necessary is *any* physical examination? Can I refer you to one
of my favourite papers of all time:
Hampton et el: "Relative contributions of history-taking, physical
examination, and laboratory investigation to diagnosis and management
of medical outpatients". BMJ 1975, 2, 486-489
This, very elegantly, looked at the suspected diagnosis at each stage
of the hospital doctor's involvement with the case. He would record
his suspected diagnosis after reading the GP's letter, after taking
the history from the patient (then record predicted management), after
examination and after investigations had been done. There were 80
patients.
The results are as follows:
Referring practioner's diagnosis unchanged: 37 patients
Diagnosis changed after history taking: 34 patients
Diagnosis changed after physical examination: 6 patients
Diagnosis changed after laboratory investigation:7 patients
Interesting, isn't it?
Toby
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