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September 1990


Am J Dis Child. 1990;144(9):963-964. doi:10.1001/archpedi.1990.02150330023014

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As a radiologist, I often feel as though I am sitting in the stands watching parade by me on requisition the fads, trends, idiosyncracies, fears, pet diagnoses, and newest disease entities from the most recent journal issues, all from physicians requesting imaging consultation. Much of the time, these favorite problems emanate from the attending pediatricians and are then mirrored by the pediatric house staff. This is an excellent mechanism for prolongation and propagation of imaging misinformation. Sometimes requests for imaging studies bear a closer relationship to the personality of the physician than they do to the concerns raised in evaluation of the patient. What has become of the physical examination? The usual approach to the patient is an evaluation of the physical condition and a careful history followed by pertinent and carefully chosen diagnostic tests. Physical diagnosis is still taught in medical schools, and the techniques and procedures have not changed substantially in the past quarter century. What has changed is the self-image of the young physician. The "Holmesian" diagnostician is no longer revered by the medical student. This image has drowned in the enormous and compelling volume ofinformation available on a molecular and

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