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July 9, 1973

Everything You Did Not Want To Know About the Patient But Were Afraid Not To Ask

JAMA. 1973;225(2):165. doi:10.1001/jama.1973.03220290051015

A favorite ploy in the one-upmanship of clinical-pathological conferences is to ask the physician who presents the case about a missing item of information in the protocol. "Did the patient have whooping cough in his childhood? Are his posterior tibial pulses palpable?" It matters little that the case relates entirely to the gastrointestinal tract. Relevance is a small consideration. And it is no consideration at all in the gamesmanship of hospital ward rounds. Pity the student who fails to mention maternal rubella or the briskness of the ankle-jerk, even if the case happens to be one of a duodenal ulcer. Completeness is a sine qua non of a history and physical examination—a fundamental dogma of clinical medicine.

Contending that a "complete" history and physical examination is neither comprehensive enough to satisfy the demands of modern medicine, nor sharply enough focussed to be relevant to the requirements of diagnosis, Michaels1