5 ms·

I think ultrasound already has replaced the stethoscope in the ED. ED physicians in the US basically all get pretty extensive training with POCUS. I truly love

I think ultrasound already has replaced the stethoscope in the ED. ED physicians in the US basically all get pretty extensive training with POCUS. I truly love and practice the physical exam, but even in my 30s feel like some kind of dinosaur in this respect. I've written letters of profound gratitude to my ultrasound director, as probably the most impactful training in preparation for my rural practice. I have literally never had an inpatient colleague -- from rural to academics -- admit a patient for eg pneumonia without an X-ray, no matter how young and otherwise healthy or how convincingly the history and vitals match my carefully documented auscultation, egophony, and percussion. It's a waste of everyone's time to even try. As a result, many of my colleagues skip the middle man and don't bother with much exam. Some don't even bring a stethoscope to work anymore. Which makes me sad.

lukko 4y ago
I think CXR in pneumonia is justified - if there's deterioration it's very helpful to have imaging at admission and consolidation on a CXR is usually expected for diagnosis (in UK), especially if the patient is requiring oxygen and sick enough for admission. I totally get what you mean though - unfortunately clinical examination is not trusted and valued. I guess POCUS is sort of just an extended clinical examination with more hardware...
haldujai 4y ago
I’m SHOCKED to read a staff physician, especially as young as you are, is performing egophany and percussion. If your comments didn’t so strongly suggest that you are a very competent and diligent physician I would honestly call BS. Good for you though, I haven’t seen these exams performed done since the clinical skills course during preclerkship of medical school. It’s honestly a running joke in my medical friend group, when we used to teach the medical students we’d have to pull out a copy of Bates and remind ourselves how to do those and whispered pectoriloquy haha.

lukko 4y ago

I think CXR in pneumonia is justified - if there's deterioration it's very helpful to have imaging at admission and consolidation on a CXR is usually expected for diagnosis (in UK), especially if the patient is requiring oxygen and sick enough for admission. I totally get what you mean though - unfortunately clinical examination is not trusted and valued. I guess POCUS is sort of just an extended clinical examination with more hardware...

haldujai 4y ago

I’m SHOCKED to read a staff physician, especially as young as you are, is performing egophany and percussion. If your comments didn’t so strongly suggest that you are a very competent and diligent physician I would honestly call BS. Good for you though, I haven’t seen these exams performed done since the clinical skills course during preclerkship of medical school. It’s honestly a running joke in my medical friend group, when we used to teach the medical students we’d have to pull out a copy of Bates and remind ourselves how to do those and whispered pectoriloquy haha.