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> -----Original Message----- > From: Rowley Cottingham [mailto:[log in to unmask]] > I felt a bit chastened by this initially, but then thought > about it. I don't think we ever fully examine a patient. > Indeed, I teach the juniors > not to examine patients exhaustively; once a management plan > is clear they should stop examining and investigating, make sure the > patient is safe and refer or treat and send home. Well said, Rowley. 'No tests that don't alter management' includes elements of clinical examination. Use your brain instead of following pathways. 'Problem Solving in Clinical Medicine: From data to diagnosis' (P Cutler; Williams and Wilkins 1979- there may be a more recent edition) covers this well- good diagnosticians refine with each question or element of examination and add or remove error correcting questions from their list until a diagnosis is reached rather than following a rigid 'clerking' model. Matt Dunn