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Comment & Response
October 4, 2016

Improving the Physical Examination

Author Affiliations
  • 1Eau Claire Family Medicine Residency, UW Health, Eau Claire, Wisconsin
JAMA. 2016;316(13):1410. doi:10.1001/jama.2016.12233

To the Editor The conclusion of the Viewpoint by Dr Nelson and colleagues1 that “A reengineered physical examination for the new millennium should aid in both disease prevention and risk stratification” has several problems.

Whether diagnosis is conceived as pattern recognition or iterative hypothesis testing, it fundamentally involves sequential acquisition of information up to the point of having sufficient certainty to allow therapeutic decisions. Diagnosis is not about knowing all the information but about knowing enough to proceed. Thus, for example, when a patient has an erythema migrans rash and the appropriate exposure risk, Lyme disease is more appropriately diagnosed based on physical examination than on laboratory testing (which may take 2-4 weeks to have a positive result).2

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