The Clinical Method and Subjectivity in Medicine

2018 ◽  
Author(s):  
J. Donald Boudreau ◽  
Eric J. Cassell ◽  
Abraham Fuks
Keyword(s):  
Physical Examination ◽  
Medical History ◽  
Medical Record ◽  
Chronic Conditions ◽  
Process Of Care ◽  
Clinical Method ◽  
Functional Assessments ◽  
Contemporary Medicine

The clinical method is defined as the means by which doctors gather information about their patients, think about and evaluate these medical facts, and enter the facts into their process of care. Its key components are the medical history, including the process by which it is acquired from patients and its subsequent documentation in the medical record, as well as the physical examination. Characteristics, such as the reproducibility and accuracy of various components, are discussed with a reference to prevailing opinions of subjectivity and objectivity in medicine. It is argued that as a consequence of a shift in the prevalence of illness, from acute to chronic conditions, a misalignment exists between the clinical method currently taught and contemporary medicine. It is suggested that a renewed and repurposed clinical method must incorporate enhanced strategies for functional assessments.

The Reliability of Medical History and Physical Examination in Patients with Acute Abdominal Pain

1983 ◽  
Vol 22 (01) ◽  
pp. 15-18 ◽  
Author(s):  
S. Brynitz ◽  
B. Bjerregaard ◽  
J. Holst-Christensen ◽  
P. Jess ◽  
Eeva Kalaja ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Physical Examination ◽  
Medical History ◽  
Medical Record ◽  
Acute Abdominal Pain ◽  
Automatic Diagnosis ◽  
Diagnosis System ◽  
Computer Assistance ◽  
Lower Accuracy ◽  
Tentative Diagnosis

The reliability of medical record information is of fundamental importance to the certainty with which a diagnosis can be made. 40 patients were chosen at random and each was examined by four clinicians. The information and a tentative diagnosis were written on a special record form. The results were judged by means of the coefficient kappa. The clinicians disagreed more on symptoms than on diagnoses. The diagnoses made by an automatic diagnosis system showed lower precision and lower accuracy than the clinicians’ diagnoses. The results of the study might explain why computer assistance in diagnostics is of limited value.

A new multisystem inflammatory syndrome temporally associated with SARS-CoV-2 in a 6-year-old boy

2020 ◽  
Vol 16 (3) ◽  
pp. 295-300
Author(s):  
Agnieszka Pawłowska-Kamieniak ◽  
◽  
Milena Wronecka ◽  
Natalia Panasiuk ◽  
Karolina Kasiak ◽  
...  
Keyword(s):  
Child Health ◽  
Physical Examination ◽  
Medical History ◽  
Royal College ◽  
New Disease ◽  
Imaging Findings ◽  
Inflammatory Syndrome ◽  
And Child Health

In December 2019, China reported cases of infections caused by a new zoonotic coronavirus, which gradually developed into a pandemic. The disease was initially believed to be mild in children. In April 2020, a possible relationship between a new paediatric multisystem inflammatory syndrome and SARS-CoV-2 was found. In May, the Royal College of Paediatrics and Child Health published the criteria for the diagnosis of this new disease. We present a case of a 6-year-old boy retrospectively diagnosed with SARS-CoV-2-related multisystem inflammatory syndrome based on medical history, physical examination, laboratory and imaging findings, as well as the available literature.

Teaching a Clinical Method Adapted to Contemporary Medicine

2018 ◽  
Author(s):  
J. Donald Boudreau ◽  
Eric J. Cassell ◽  
Abraham Fuks
Keyword(s):  
Clinical Observation ◽  
Skills Training ◽  
Spoken Language ◽  
Communication Skills Training ◽  
Clinical Method ◽  
Medical Interviewing ◽  
The Status ◽  
Clinical Thinking ◽  
Contemporary Medicine ◽  
Person Centered Approach

A truly person-centered curriculum requires important changes to how the clinical method is taught. Medical interviewing demands explicit instruction in how the spoken language works and specific strategies that elevate the status of attentive listening so that this aspect is seen as important as the more mechanical aspects of traditional communication skills training. The term chief complaint is declared outdated and suggestions for its replacement are offered. The medical record is considered an important educational instrument, and recommendations are made so that it is in service of functional assessment and better aligned to a person-centered approach. Modifications to the physical examination, particularly a renewed emphasis on clinical observation, are outlined. The chapter concludes with a discussion of clinical thinking and judgment. A plea is made for inculcating a receptiveness toward a narrative competence within medicine.

scholarly journals DECLINE OF CLINICAL ART AND TECNOLOGICAL MEDICINE BOOM

2021 ◽  
pp. 123-133
Author(s):  
José Antonio Rodríguez Montes
Keyword(s):  
Physical Examination ◽  
Medical History ◽  
Medical Practice ◽  
New Technologies ◽  
Clinical Skills ◽  
Treatment Plan ◽  
Correct Diagnosis ◽  
Bedside Teaching ◽  
The Past

Currently there is a consensus that the clinical art have been greatly deteriorating during the past 50 years. This problem has raised worldwide attention through as increase in publications, courses, symposia and congress. The erosion of bedside teaching and the consequent decline of clinical skills, notably wrongfull and inadequate use of new technologies. At as result, it becomes difficult if not impossible obtain an appropiate collection of the synptoms sufferick for the sick. Together with the medical history, the physical examination is mandatory for the correct diagnosis and developing the treatment plan. In this paper, the decline of clinical art is exposed and how this ancient heritage of medical practice can be recovered.

scholarly journals A submandibular nodule revealing a relapsed bladder urothelial carcinoma

2021 ◽  
Vol 12 (e) ◽  
pp. e10-e10
Author(s):  
Aya Khemir ◽  
Nada Mansouri ◽  
Faten Gargouri ◽  
Fethi Bougrine
Keyword(s):  
Bladder Cancer ◽  
Physical Examination ◽  
Urothelial Carcinoma ◽  
Medical History ◽  
Tumor Cells ◽  
Microscopic Examination ◽  
Survival Rates ◽  
Cytokeratin 20 ◽  
Cytokeratin 7 ◽  
Total Recovery

A 69-year-old patient treated for infiltrating bladder transitional carcinoma many years ago presented with a submandibular nodule. The last was fortuitously discovered by the patient a month before he presented to consultation. Physical examination showed a firm subcutaneous nodule of 0.5 cm in diameter in the right submandibular region. At this level skin was inflamed/red and swollen. Otherwise physical examination was within normal. The described nodule above was biopsied. Microscopic examination showed infiltration of the dermis by a carcinomatous proliferation (Fig. 1). Tumor cells were arranged in small nests and clusters surrounded by a fibrous stroma. Tumor cells showed moderate nuclear atypia. Immunohistochemical staining showed positivity of tumor cells for Cytokeratin 7 and P63 (Fig. 2). Therefore, taking into consideration patient’s medical history, microscopic and immunohistochemical findings the diagnosis of CM from urothelial carcinoma was retained. The first case of CM from bladder carcinoma was reported in 1909 [3]. Since then many case have been reported [1,2]. According to cases reported in literature so far, the mean interval of time between the setting of bladder cancer and the appearance of CM is of 18 months approximately. Large tumor size and deep infiltration of the bladder wall are predictive factors of CM. However, cases of CM associated with superficial bladder carcinomas were reported [3]. The certain diagnosis is based on microscopic examination [1,3]. Pathologists should be aware of patient’s medical history to facilitate the diagnosis and choosing appropriate immunostains if necessary especially in front of a poorly differentiated carcinoma[3]. Urothelial carcinomas express Cytokeratin 7 and Cytokeratin 20 antibodies [3]. The occurring of CM in case of bladder cancer darken the prognosis [1,2]. Median survival rates are less than 12 months in published cases so far [1,3]. Treatment consists of chemotherapy if the patient could bare it [1]. Total recovery was detected in 70% of cases of CM treated with chemotherapy. Yet, it does not improve global survival rates [3].

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