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May 28, 1997

The Rational Clinical Examination: Detecting Abnormal Systolic Murmurs

Author Affiliations

Portland, Ore

JAMA. 1997;277(20):1594. doi:10.1001/jama.1997.03540440028023

To the Editor.  —I enjoyed the article on detecting abnormal systolic murmurs by Dr Etchells and colleagues1 As I read through the details of aortic stenosis and simultaneous inflation of 2 sphygmomanometers to accentuate left-sided murmurs, it occurred to me that I know very few physicians actually performing such detailed examinations. It seems that data collection, interpretation of flow velocities, multiple gated acquistion scans, magnetic resonance imaging, and echocardiogram results are more important skills than the sublety of the bedside examination.Bedside clinical rounds also seem to be a rarity and are held only by the older physicians; nowadays, laboratory printouts and "chart flips" seem to suffice. Clinical skills seem to be an added bonus, but not essential.The way to change this is to realize that examinations motivate students and that improved clinical skills can be attained only by strict, rigorous criteria, such as formal bedside examinations. Many skilled acrobats are

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