Recently, I was evaluating a patient with my housestaff team. After I pointed out a physical finding that the residents had not noticed, it occurred to us that fewer imaging studies might have been ordered if that important physical finding had been noticed earlier. I informed my resident team that soon The American Journal of Medicine would introduce a new feature focusing on important physical examination findings.
The physical exam feature began in late 2007 and will continue through 2008. This new Journal section focuses on important clinical signs in physical examination while another new venture will concentrate on strategies to improve clinically effective healthcare. The physical exam feature was suggested by Dr. Thomas Marrie, Dean of the University of Alberta’s College of Medicine and Dentistry. During the annual scientific meeting of the American College of Physicians, we fell into a discussion concerning the unfortunate decline in physical examination skills. The enormous and often amazing growth of medical imaging technology has so captured the imagination of physicians that at times imaging tests are employed as part of a routine diagnostic evaluation before a careful physical examination has been performed. Both Dr. Marrie and I agreed that often unnecessary and expensive imaging studies could have been avoided if the responsible physician had been more meticulous in examining the patient.
In an effort to improve the diagnostic acumen of current practitioners, the Physical Findings Section will detail in words and pictures important physical features that would point the examining physician in the direction of the correct diagnosis. Of course, imaging studies still might be obtained for patients with important physical findings. However, the imaging tests would be more focused if the responsible clinician recognized the presence of the clinically relevant physical finding. The Journal’s editorial board has endorsed enthusiastically this new physical examination feature. We think you will find it both helpful and insightful.
The second new Journal feature arose out of increasing interest in both academic and community practice for methods to improve the quality of healthcare delivery. Physicians routinely encounter problems in the attempt to deliver efficient, cost-effective, and safe medical care. Medical errors are common and can be the result of knowledge deficits on the part of physicians or defects in specific healthcare systems in which clinicians perform their daily work. Governmental and non-governmental organizations throughout the world have been focusing attention on ways to decrease the number of costly, morbid, and even mortal errors that occur in our healthcare systems. One specific example of a strategy to improve efficient and safe medical care is the advent of anticoagulation clinics or units to replace individual physician control of warfarin anticoagulation. It has been documented a number of times that such clinics, administered usually by nurses or pharmacists, enable patients to be anticoagulated in a fashion that is both safer and more effective as compared with control by an individual practitioner. This is but 1 small example of a system technique that produces safer and more effective medical care delivery.
The board of directors of the Association of Professors of Medicine (APM), the endorsing body for the Journal, has suggested that the Journal publish material that would assist practicing physicians in academia and the community in the delivery of safer, more efficient, and effective healthcare. The Journal’s editorial board agreed with this position, and in 2008 the Clinical Effectiveness section will premier. Edited by Dr. Kim A. Eagle and Dr. Elizabeth A. Jackson of the University of Michigan Medical School, this new series will present concise, practical approaches to the delivery of more effective, efficient, and safe medical care. This new feature will appear in early 2008; 6 Clinical Effectiveness articles are planned for the year. The editorial board and I hope that this new section will assist practicing physicians in improving their delivery of medical services.
Both the Physical Findings and the Clinical Effectiveness article types have been added to the Journal’s online submission system. Contributions are welcome.
The Journal’s editorial board and staff wish all of our readers a happy, safe, and productive 2008. We believe that the Journal will continue to assist clinicians in delivering the best possible medical care to their patients, and we welcome your comments.
— Joseph S. Alpert, MD
This article was originally published in the January 2008 issue of the American Journal of Medicine.
