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June 2017

Hiding in Plain Sight—Resurrecting the Power of Inspecting the Patient

Author Affiliations
  • 1Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 2Department of Medicine, VA Ann Arbor Healthcare System & University of Michigan, Ann Arbor
  • 3Institute of Health Policy, Management & Evaluation and Department of Medicine, University of Toronto; Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
JAMA Intern Med. 2017;177(6):757-758. doi:10.1001/jamainternmed.2017.0634

In the not so distant past, physicians learned their patients’ stories through the history and physical examination, with key findings supplemented by test results and information from the paper medical records or “chart.” In the current era, the order is reversed. Physicians often begin by searching the electronic medical record and then supplement this information by talking to and examining the patient.1 A properly designed electronic medical record allows for an efficient search of the patient’s medical and social history, physical findings, test results and clinicians’ opinions and plans. An unintended consequence of deriving information from the electronic medical record instead of the patient, however, has been an atrophy of the powers of clinical observation. Inspection is a diagnostic, prognostic, and humanistic tool, as we have learned from our patients and teachers over the last 4 decades. In the spirit of old-fashioned clinical teaching, we seek to pass on (hopefully) valuable lessons from one generation to the next.

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