Veterinary Medicine - October 2008 - (Page 534)

Leading Off Why the physical exam is still really necessary David Robbins, DVM hen Ludwig, a 6-year-old Boxer, came in for his annual vaccinations and physical examination, he was showing signs of abdominal discomfort and had difﬁculty walking on his hindlimbs. My physical exam ﬁndings were normal except for apparent pain on abdominal palpation and unilateral cryptorchidism. Thus, I suspected that Ludwig had a retained testicle and that it could be causing a problem. I reviewed Ludwig’s medical chart and could ﬁnd no mention of a retained testicle. In fact, the medical record identiﬁed Ludwig as neutered. W could have prevented this had one been done sooner. OUR MOST FUNDAMENTAL DIAGNOSTIC TOOL The physical exam is the routine assessment of a patient by using our ﬁve senses and minimally invasive techniques, using for example a stethoscope, not a colonoscope.1 Together with the patient’s history, the physical exam helps us determine whether additional diagnostic tests are indicated, and, if so, which tests will be most useful. The physical exam is among the few David Robbins, DVM VCA West Bernardo Animal Hospital 11605 Duenda Road, Suite D San Diego, CA 92127 The physical exam is among the few commonalities in veterinary medicine, practiced by every veterinarian in every country. I discussed my ﬁndings with the owner, who proceeded to tell me that in all the years of coming to the practice for exams, no one had ever mentioned the retained testicle. Furthermore, the owner said that no one had ever examined Ludwig’s private region. She said, “They always seemed in a hurry to just vaccinate.” It turned out that Ludwig’s retained testicle was cancerous. Unfortunately, by the time I saw Ludwig, the cancer had already spread throughout his abdominal cavity. However, it makes you wonder if a complete physical exam commonalities in veterinary medicine, practiced by every veterinarian trained in every country. Anyone who has practiced or observed veterinary medicine in an economically challenged setting knows the physical exam is often the only method available for diagnosing a patient’s illness. IS BEING DEVALUED However, as technology continues to evolve in veterinary medicine, I am concerned about the future role of the physical exam in our profession. From advanced imaging in veterinary refer- ral centers to sophisticated tests now available routinely in outpatient settings, technology has altered the way we diagnose, treat, and palliate disease. Are we putting too much emphasis on technology instead of on the physical exam? And, if so, is it changing the way we view the physical exam? In my opinion, we are beginning to see the role of the physical exam de-emphasized. I have noticed more practitioners spending less time obtaining or reviewing a history and performing cursory physical exams in sick and healthy patients almost out of a need to be loyal to the process rather than valuing the information gathered. In modern veterinary medicine, diagnostic tests have supplanted clinical skills. Rather than relying on detecting a murmur during auscultation, we use an echocardiogram to tell us whether a patient has mitral insufﬁciency. And magnetic resonance imaging (MRI)—not a neurologic exam—tells us whether our patient has a brain lesion. It may be easy to say that the physical exam is losing some of its potency because we are busier than ever and have less time to perform thorough physical exams. Although deﬁnitely a factor, our lack of time only partly explains this change. A decreased emphasis on physical exam skills in 534 October 2008 VETERINARY MEDICINE

Table of Contents Feed for the Digital Edition of Veterinary Medicine - October 2008

Veterinary Medicine - October 2008 Contents Leading Off Clinical Exposures Idea Exchange Stalking Stones Vaginitis in Dogs CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - October 2008

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