Is it Time to Replace Physical Examination with a Hand-Held Ultrasound Device?

Attempts at using physical examination (PE) go back centuries, with inspection, palpation, and percussion being the mainstay of this approach until 2 centuries ago when the stethoscope was invented and auscultation became probably the most important element of PE for patients with known or suspected cardiovascular disease (CVD). Despite its several limitations, PE is still used, sometimes as the only means, of evaluating and following patients with CVD. In this paper I shall argue for the substitution of this inaccurate and archaic approach by direct visualization of the heart using a hand-held ultrasound (HHU) device. I am not in any way suggesting the substitution of a comprehensive echocardiographic examination by an expert sonographer/echocardiographer by HHU in patients with significant CVD. Instead, I am arguing for the replacement of PE for evaluation of the heart at the point of care as well as at the bedside, simply because HHU is more accurate and provides more meaningful information.