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Importance of Clinical Examination Skills in Paramedical Training

Submitted by on January 31, 2016 – 7:10 PM

Dr. David RiceDuring clinical rounds, medical house officers discuss patients with the consultant. These discussions include patient’s history, their present complaints and supporting labs to reacha specific diagnosis. I found these rounds very knowledgeable because we can integrate multiple laboratory findings and their relation to different symptoms at a time. As every individual is different in terms of their response to a specific disease and specific drug, every time there is a new thing to learn at these clinical rounds.

 

In these discussions I noticed that besides medical investigation the physician mostly focuses on the findings of physical examinations. I enquired with the physician regarding the many new technologies in the hospital which could make our work easier. One can diagnose the exact cause of disease through use of these technologies, then why is there still a need to remember the specific clinical signs. The physician replied that these findings not only help us in understanding the diagnosis but also decrease the economic burden of patient.

 

Some of the diseases can be easily identified through the physical examination and there is no need to ask the patient to do so many expensive procedures. He further suggests that we should think from the patient’s point of view also, because he is the one who has to pay for all these expenses. If we over burdenthe patient he would not be able to afford the actual expenses of medications. So it is important to have the appropriate knowledge of clinical examination and one should utilize them in daily practices.

 

This scenario stood out for me due to many reasons. First of all, there are few doctors who think from the perspective of the patients, because they need ease in their life so they prefer multiple tests to diagnose the patient. Secondly, as physician mentioned that many diseases are there which could be diagnosed on the bases of clinical signs, so it not only decreases the economic burden on patient but also on the country as well. Thirdly, in past days when there were no new technologies, at that time physicians were relying on clinical signs and making diagnosis and were treating patients accordingly.

 

While reflecting on the above scenario many questions were arising in my mind such as, how competent are doctors and nurses in terms of assessing patients through physical examination? What is the other literature highlighting regarding the importance of clinical signs? And last but not least what are some of the diseases that can be identified through clinical signs so that there is less need to do any expensive procedures.

 

According to Bruno (2011) the use of diagnostic tests is a crucial aspect of clinical practice since they assist clinicians in establishing whether a patient has or does not have a particular condition. In order for any clinical test to be used most appropriately, it is essential that several parameters be established regarding the test and that these are made known to clinicians to inform their clinical decision making. A study conducted by Mehraj, Naqvi,  Hafeezuddin, & Waqas (2012) concluded that many studies advocate routine medical imaging despite of the fact that their study showed that clinical evaluation is still the dominant part of the management of patient with suspected acute appendicitis before considering medical imaging.

 

Mehraj et. al. (2012) further suggests that identification of the disease through clinical signs is highly dependent on the clinical experiences and practices of the physician. As in the study Mehraj et. al. (2012) concluded that appendicitis is one of the disease that could be identify through physical examination and there is only the need to confirm it before surgery through ultrasounds. The other diseases include early osteoporosis and ankylosing spondylitis.

 

While reflecting back on the scenario of the clinical rounds, it was the decision of the physician to emphasize on the clinical signs. It may be that others continue with the same practice of conducting expensive procedures for each and every small step in identifying disease.

 

In conclusion, all paramedical staff members need to get trained in order to gain the skills of physical examination. These skills not only help to enhance clinical experience but also decrease the burden of expenses on the patient. In a country like Pakistan, people are often hand to mouth financially.

 

People do not have any support from the government and have limited amount to spend on their health. In all these circumstances if a physician asks them to do multiple tests for the diagnoses of a simple disease, people could get exhausted and never come back to continue his treatment. Therefore, the physician with good clinical expertise manages patients smartly with his skills and also reduces the economic burden so the patient could continue with further treatment.

 

Reference

Bruno, P. (2011). The importance of diagnostic test parameters in the interpretation of

clinical test findings: The prone hip extension test as an example. Journal of Canadian Chiropractic Association, 55(2), 69 – 72.

Mehraj, A., Naqvi, M. A., Hafeezuddin, & Waqas. (2012). Importance of clinical assessment

in diagnosis of acute appendicitis and its role in decreasing negative appendectomy rate. Journal of Ayub Medical College Abbottabad, 24 (2), 7 – 9.

Morgan, W. J., & Brown, M. A. (2000). Clinical Assessment and Diagnostic Approach to Common Problems.

Manias E&Street A(2001). Nurse-doctor interactions during critical care ward rounds.

 

 

About the Author: Shireen Arif, MSN, BScN, RN, RM is a Senior Instructor at Ziauddin University, College of Nursing, Pakistan. She can be reached at suz83k2000@yahoo.com

About this article: This article is competing for the JPMS International Medical Writing Contest 2015.

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