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In Reply Dr Cayley argues that careful physical examination remains an important tool in medical diagnosis not easily replaced by imaging and laboratory testing. We agree wholeheartedly, advocating improvement of the physical examination rather than its abandonment. A well-collected history, inventory of symptoms, and constellation of physical findings are often sufficient to permit establishment of timely diagnoses that can direct treatment. Also, the ease by which physical examinations can be repeated while serious illness evolves allows iterative refinement of provisional diagnoses and diligent monitoring of response to treatment. The purpose of reengineering the physical examination, embracing measurement science principles of reliability, repeatability, and reproducibility, would be to augment its already established value as a diagnostic tool.
Nelson WG, Rosen A, Pronovost PJ. Improving the Physical Examination—Reply. JAMA. 2016;316(13):1410–1411. doi:10.1001/jama.2016.12236
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