The bedside evaluation, consisting of the history and physical examination, was once the primary means of diagnosis and clinical monitoring. The recent explosion of imaging and laboratory testing has inverted the diagnostic paradigm. Physicians often bypass the bedside evaluation for immediate testing and therefore encounter an image of the patient before seeing the patient in the flesh. In addition to risking delayed or missed diagnosis of readily recognizable disease, physicians who forgo or circumvent the bedside evaluation risk the loss of an important ritual that can enhance the physician–patient relationship.
Patients expect that some form of bedside evaluation will take place when they visit a physician. When physicians complete this evaluation in an expert manner, it can have a salutary effect. If done poorly or not at all, in contrast, it can undermine the physician–patient relationship. Studies suggest that the context, locale, and quality of the bedside evaluation are associated with neurobiological changes in the patient. Recognizing the importance of the bedside evaluation as a healing ritual and a powerful diagnostic tool when paired with judicious use of technology could be a stimulus for the recovery of an ebbing skill set among physicians.
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Author, Article, and Disclosure Information
From Stanford University School of Medicine and Stanford University, Stanford, California; Western Kentucky University, Bowling Green, Kentucky; and GlaxoSmithKline, King of Prussia, Pennsylvania.
Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0676.
Corresponding Author: Abraham Verghese, MD, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, S102, Stanford, CA 94305-5110.
Current Author Addresses: Dr. Verghese: Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, S102, Stanford, CA 94305-5110.
Dr. Brady: Department of Folk Studies and Anthropology, Western Kentucky University, 1906 College Heights Boulevard #61029, Bowling Green, KY 42101-1029.
Dr. Kapur: Department of Anthropology, Stanford University, Sweet Hall, 590 Escondido Mall, Stanford, CA 94305-3023.
Dr. Horwitz: GlaxoSmithKline, 709 Swedeland Road, King of Prussia, PA 19406.
Author Contributions: Conception and design: A. Verghese, E. Brady, C.C. Kapur, R.I. Horwitz.
Analysis and interpretation of the data: A. Verghese, E. Brady, C.C. Kapur, R.I. Horwitz.
Drafting of the article: A. Verghese, E. Brady, C.C. Kapur, R.I. Horwitz.
Critical revision of the article for important intellectual content: A. Verghese, E. Brady, R.I. Horwitz.
Final approval of the article: A. Verghese, E. Brady.
Administrative, technical, or logistic support: A. Verghese.
Collection and assembly of data: A. Verghese, E. Brady, R.I. Horwitz.

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