Making Rounds: Medical Education Documentary Film
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Channel: Mount Sinai Health System
Views: 3,518,915
Rating: 4.7235298 out of 5
Keywords: Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, Valentin Fuster, Herschel Sklaroff, Middlemarch Films, cardiac care unit, medical education, training, bedside, diagnosis, exam, heart, heart disease, heart failure, heart attack, critical care, cardiology, Mount Sinai, Your, Broken, Making Rounds, Documentary (TV Genre), medicine, technology
Id: 8LZJz7GtJA0
Channel Id: undefined
Length: 63min 17sec (3797 seconds)
Published: Wed Apr 22 2015
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The physical exam seems highly over-romanticized in medicine. One of the things that has always struck me is that for any new diagnostic test or imaging method, there is always a investigation of sensitivity, specificity, NNT, etc. However, in medical school, we are taught and tested on aspects of the physical exam without any meaningful discussion of the same standards of evidence.
One of my favorite examples is cardiac auscultation. How many hours in med school and residency is spent trying to tease apart and remember crescendo vs. crescendo-decrescendo, or split S2 vs. S3 vs. S4. And you can be guaranteed that on USMLE and internist board exams there will be a few questions listening to murmurs on every exam. Yet, in a small study comparing medical students with 18 hours of training using handheld ultrasound to board certified cardiologists using auscultation , the medical students had significantly higher sensitivity and specificity in identifying both valvular and non-valvular pathology.
Similarly, much time is spent on the auscultation characteristics of pneumonia. Yet in a meta-analysis of physical exam findings in childhood pneumonia no auscultation finding could significantly distinguish pneumonia from normal lung. The only things that could were O2 sat, tachypnea, and evidence of respiratory distress, hardly subtle "art-of-medicine" physical exam pearls.
In general, the physical exam seems like a great, inexpensive way to try to screen patients, especially when true diagnostic testing would be either expensive or comes with risks. However, we should also strive to understand the true accuracy of the exam compared to alternatives. The Rational Clinical Exam is a great resource for this, though is often discouraging...
There is so much hind-sight bias in this video.
So much disdain for the primary care physicians who "missed the diagnosis." It's a lot easier to look back and play Monday morning quarterback and point out the cardiac cause of their vague symptoms when your patient is currently sitting in front of you in a cardiac ICU. Physical exam or not.
Ah yes this attitude
I try and keep it in mind when rounding on my 15th patient of the morning who can only say ROODLE ROODLE ROODLE but honestly sometimes you just gotta go by the labs
Radiation oncologist here. No thanks, I’ll keep my technology, and keep adding more.
Seemed like pretty routine rounds to me, not sure why people think this is extremely rare in that /r/Documentaries thread
The best rounds are a mix of patient discussion and teaching... unless you're super busy, then the best rounds are the ones that end to give you enough time to finish your work before noon conference
The truth is, 50% of elderly patients where I work probably don’t have a clue why they’re in the hospital. Another 20-30% can barely get their story straight, or seem to think they know the diagnosis already and there’s no point telling me the symptoms. (E.g. me trying to ask about the character of the headache. Them: it feels like my brain’s not getting enough oxygen.) Patients and family members making up symptoms that are not there, especially on the systemic review is the worst.
A physician where I live is being sued right now for putting his stethoscope on the bare breast of a female patient because she went to see him for a URTI. In this kind of climate honestly I’d rather not do a proper chest examination. It’s a CXR every time for me (inpatient)
Thanks. I hate it.
The classical PE is fine enough but this whole “don’t trust technology” thing is just one of the remains of the previous generations of doctors who always had to know everything (even when they knew jack shit) and whose sole opinion was enough to dismiss other people’s based on age and rank. It’s the whole “oh I had to sufffer through tons of hours studying this now obsolete method, so you being younger need to do that too so I can consider you worthy of my respect” mindset that’s damaging so many patients and physicians alike, and it has to go
If humankind goes into a mad max kind of scenario and I have to go back to drinking piss to diagnose diabetes so be it but meanwhile I’ll take the diagnostic precision over flexing on my colleagues thank you
That whole "atypical chest pain" in that diabetic woman was frustrating. They had a knowledge gap, they didn't know that right sided arm pain has a high LR for being an ischaemic cause.