现代医生应该有什么样的技能？听听斯坦福医学院的教授们怎么说。

以前曾经听说过斯坦福医学院的Stanford Medicine 25，是一个培训医学生和住院医bedside skills的项目，恰好坛里最近在讨论有关内容，去查了一下。关于physical examination的角色和重要性，下面有三篇他们近期发表在学术期刊上的文章。供有兴趣的同学阅读。

Editorial in the British Medical Journal: In Praise of the Physical Examination （2009）

quote:

We argue that clinicians who are skilled at the bedside examination make better use of diagnostic tests and order fewer unnecessary tests. If, for example, you recognise that the patient’s chest pain is confined to a dermatome and is associated with hyperaesthesia, and if you spot a few early vesicles looking like dew drops on rose petals, you have diagnosed varicella zoster and spared the patient the electrocardiography, measurement of cardiac enzymes, chest radiography, spiral computed tomography, and the use of contrast that might otherwise be inevitable. And so many clinical signs, such as rebound tenderness, lid lag, tremor, clubbing, or hemiparesis cannot be discerned by any imaging test.

Perspective in the New England Medical Journal: Patient as Icon, Icon as Patient [PDF,2008]

quote:

For the clinician, the bedside is hallowed ground, the place where fellow human beings allow us the privilege of looking at, touching, and listening to their bodies. Our skills and discernment must be worthy of such trust.

Editorial in the Journal of General Internal Medicine: The Physical Exam and Other Forms of Fiction [PDF, 2010]

quote:

The new era of health care reform will probably bring with it a new level of accountability; it is unlikely that the promiscuous ordering of imaging and other lab tests can continue to conceal the problem of poor physical exam skills. Even as we continue to refine our understanding of the accuracy of a physical sign and examine its operating characteristics, we must also leave each of our trainees with the sense that after three years they have acquired a uniform set of skills that they can bring to the patient’s bedside. One certain way to guarantee such uniformity is to put in place a national, highstakes clinical skills exam. It seems short sighted for “board certification” in internal medicine to be based on a multiple choice exam; it is yet another form of fiction to assume that everyone who passes that hurdle has acceptable skills in examining the patient. We can surely hold ourselves to a higher standard.

最后，New York Times Article: Physician Revives a Dying Art: The Physical (2010)

所有跟帖： 

• 谢分享。任一种均不可偏废，各具优势与欠缺，结合运用最好。 -jck6- ♀ (0 bytes) () 01/07/2012 postreply 22:22:21

• 这个就是我想说的。 -viewfinder- ♀ (0 bytes) () 01/07/2012 postreply 22:26:04

• 这种东西你们外面人只不过看看热闹而已 -音乐家- ♀ (849 bytes) () 01/08/2012 postreply 07:33:15

• 写了忽悠外行人的。所谓医学院教授，搞学术的，实际中不是那么回事。 -差点减肥成功- ♀ (0 bytes) () 01/08/2012 postreply 08:11:35

• 注：这里不是在讨论美国的医生会不会做肝脏触诊。他们会不会，我真不知道。 -viewfinder- ♀ (65 bytes) () 01/08/2012 postreply 08:59:05