I was taught that diagnosis was 80% history and 20% physical exam, but during my career I watched both whither as labs and radiology became more sophisticated. I have two anecdotes to share.
A partner of mine volunteered for Doctors Without Borders in Africa. Amongst his fellow doctors were two from Pakistan. He told me that their abilities to help make diagnosis using physical exam were remarkable. The obvious reason for this was that in their own country, they did not have easy access to either labs or simple x-rays.
The other is my own experience with a stethoscope. At 18 months a toddler that I had caught/delivered was less than 5% for weight and length. It was time to begin the work up for failure to thrive. Since his mother had been my patient, I had the advantage of knowing the key historical fact that she was a type 1 diabetic. So before I ordered a bunch of labs , I listened to his heart for a long time and did hear a murmur. (Children of diabetic mothers have an increased risk of ventricular septal defects.). He was referred to the pediatric cardiologist and his VSD was repaired. At that time, an echocardiogram would not have been part of a FTT work up. My point is that sometimes the stethoscope is still valuable.
And as a nice twist of a small town story, that child, now 40, has been my phlebotomist for the past decade.
I was taught that diagnosis was 80% history and 20% physical exam, but during my career I watched both whither as labs and radiology became more sophisticated. I have two anecdotes to share.
A partner of mine volunteered for Doctors Without Borders in Africa. Amongst his fellow doctors were two from Pakistan. He told me that their abilities to help make diagnosis using physical exam were remarkable. The obvious reason for this was that in their own country, they did not have easy access to either labs or simple x-rays.
The other is my own experience with a stethoscope. At 18 months a toddler that I had caught/delivered was less than 5% for weight and length. It was time to begin the work up for failure to thrive. Since his mother had been my patient, I had the advantage of knowing the key historical fact that she was a type 1 diabetic. So before I ordered a bunch of labs , I listened to his heart for a long time and did hear a murmur. (Children of diabetic mothers have an increased risk of ventricular septal defects.). He was referred to the pediatric cardiologist and his VSD was repaired. At that time, an echocardiogram would not have been part of a FTT work up. My point is that sometimes the stethoscope is still valuable.
And as a nice twist of a small town story, that child, now 40, has been my phlebotomist for the past decade.