According to that old story, a local giving directions to a lost traveler says, “If I wanted to get there, I wouldn’t start from here.” Medicine finds itself far from the bedside,1,2 seeking a way back, unsure where to begin.
That we have wandered far afield is plain to see. Core bedside skills of history taking and physical examination—still vital to comprehensive assessment, diagnostic accuracy,3 and truly patient-focused care—are taught and assessed in the first two years of medical school but largely ignored once the student reaches the clinical years.4 During residency, development of these skills is assumed when in fact they wither further.5 The physical examination of newly admitted patients is often cursory and, what is worse, perverted by drop-down boxes into an exaggerated and invented form that reads better than the truth.
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