Clinical examination: still a tool for our times?

Physical diagnosis, as an integral part of the diagnostic process and as a central component of the physician-patient relationship, is at a crossroad. Technology offers a more sophisticated and, in many instances, more accurate solution to diagnostic problems, while evidence mounts suggesting that students' and residents' physical diagnosis skills are inadequate. For several reasons, however, physical diagnosis must remain a core skill for clinicians, particularly for those who practice in outpatient settings. Recent literature critically appraising specific physical diagnosis maneuvers has identified the components of physical exam that are well worth learning and using, as well as the specific clinical conditions in which physical exam can and should play a central diagnostic role. Interestingly, critical appraisal of physical diagnosis also underscores the importance of proper technique. Thus, physical examination now can be approached as a science, based upon sound evidence, and as an art as well.