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To the Editor.—Physical findings in a patient suspected of having an "acute abdomen" remain paramount in the assessment of the diagnosis. Every surgeon has seen a patient with minimal disturbance of temperature, pulse rate, white blood cell count, and with no abnormal roentgenographic findings, and who has localized tenderness that is proved to be due to acute appendicitis. It is sometimes difficult, especially in children and in emotionally disturbed patients, to be sure that the tenderness is real.
For some considerable time, I have used a simple "trick" to elucidate whether the patient's pain is either real or exaggerated. It consists of palpating the abdomen a second time with the diaphragm of a stethoscope after clearly indicating to the patient that one is listening to the abdomen. This seems to distract the patient, for it is surprising how frequently the findings by hand palpation are not confirmed by pressing
MEYEROWITZ BR. Abdominal Palpation by Stethoscope. Arch Surg. 1976;111(7):831. doi:10.1001/archsurg.1976.01360250107028
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