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October 28, 1992

The Rational Clinical Examination-Reply

Author Affiliations

McMaster University Hamilton, Ontario

JAMA. 1992;268(16):2165-2166. doi:10.1001/jama.1992.03490160034012

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In Reply.  —On behalf of the over 60 collaborators in The Rational Clinical Examination enterprise, I thank our correspondents for their letters, for they will show us how to improve the series.Dr Scheller echoes our call for the widespread adoption of the rational clinical examination, but identifies two possible impediments. First, he raises the spectre of being sued for failing to reduce one's assessment of today's probability of ascites (in a man who will be followed for his clear-cut alcoholism) from very unlikely, based on examining him, to virtually impossible, based on sending him for an ultrasonogram anyway. Does "defensive medicine" constitute a legitimate cause for failing to apply the science of the art of the clinical examination, or is it simply a lazy excuse for not learning it? If the former is true, what an awful way to have to practice medicine! And we are wrong to think