History taking and physical examination DQ

Part 1

Question 1

Clinicians traditionally incorporate history taking and physical examination as an integral component in the evaluation, assessment, diagnosis, planning, and implementation of care. With the advent of ever-more sophisticated diagnostic tools, some individuals propose that these new tools and innovations ultimately can replace the history and examination. Is that a good idea? Why or why not? Support your position with a minimum of two references.

Question 2

Reflect back on the course content and on the various diagnostic and screening tools and procedures that have been recommended or incorporated as best practices for the differing body systems or special populations. Which of these do you perceive as having the greatest value and benefit and why? Which of these do you perceive as having the least value or benefit and why? How could you improve a tool or procedure to achieve better information in order to provide better or realize better results?

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Part 2

DQ-1

I do not think the history and physical should be replaced by new and sophisticated diagnostic tools. Early patient history taking involves taking the patient current medical history where we the patient get a chance to verbalize known medical problems. We then we take the patient family history. The family history may point out possible complications that the patient may be at risk of such as high blood pressure. For example, if the patient family member has problems with blood pressure you may suspect that the patient is at risk of developing blood pressure problems. Genetics are shared between family members and may bring up the same problems for multiple family members in the future. There may be an association between family history and health problems indicators (Isaykina,Rozanov, Aleksandrov, Leontyeva,Kotova, Ivanova, 2020). Part of the physical assessment is educating patient on self-breast examination and self-testicular examination. These early examinations may help early detection of breast cancers and may provide early insight of potential developing cancers (Wu,Lee, 2019). On another note, physical assessments may help the clinician hone down on an acute problem and may enable the clinician to have early treatment to a patient having acute symptoms.

History taking and physical examination DQ

Yu. Isaykina, V. B. Rozanov, A. A. Aleksandrov, I. V. Leontyeva, M. B. Kotova, & E. I. Ivanova. (2020). Association of Family History of Cardiovascular Diseases in Boys Aged 12-13 Years with Structural and Functional Indicators of the Left Ventricle and Arterial Stiffness in the Age of 43-46 Years (Results of 32-Year Prospective Follow-up). Racionalʹnaâ Farmakoterapiâ v Kardiologii, 15(6), 854–863. https://doi.org/10.20996/1819-6446-2019-15-6-854-863

Wu, T.-Y., & Lee, J. (2019). Promoting Breast Cancer Awareness and Screening Practices For Early Detection in Low-Resource Settings. European Journal of Breast Health, 1, 18. https://doi.org/10.5152/ejbh.2018.4305

DQ-2

I can see how theses advances in healthcare technologies would be able to support and augment practitioner assessment skills and improve patient outcomes, but not completely replace them. The technology that we have now, such as EMRs has helped us be more productive and have more interaction with patients. I can also see it coming in handy with special concerns relating to the management and control of the spread of infectious diseases, minimizing person-to-person contact and to reduce unnecessary medical staff exposure.

According to Asif, Mohiuddin, Hasan, and Pauly (2017), high quality, safe patient care involves the proper choice of investigations guided by logical clinical decision-making, which looks at a thorough clinical history and physical exam. Unfortunately, recent studies have shown an already decline in physical examination skills among healthcare providers. Ahuja (2019) contributes this to the improvements in technology, time constraints, and uncertainty that stems from a lack of confidence in physical exam skills.

I am unsure how these new technologies would replace traditional physical exams, especially in areas such as pain management and neurology, which require patient-provider interaction and critical thinking for interpreting ambiguous cases. I also do not see these new technologies replacing the traditional provider-patient relationship. Patients with chronic health issues who are required to regularly see their providers, such as dialysis or cancer patients, may rely on those visits as their only source of human interaction . Such forms of human interaction cannot be replaced by a robot.

Ahuja A. S. (2019). The impact of artificial intelligence in medicine on the future role of the physician. PeerJ, 7, e7702. https://doi.org/10.7717/peerj.7702

Asif, T., Mohiuddin, A., Hasan, B., & Pauly, R. R. (2017). Importance Of Thorough Physical Examination: A Lost Art. Cureus, 9(5), e1212. https://doi.org/10.7759/cureus.1212

DQ-3 History taking and physical examination DQ

As I reflect back on the course, there were several tests and diagnostic procedures that may help. Some of these procedures and diagnostics may not be super helpful but they do provide certain information. I believe the bone mineral density diagnostic tool is super important in assessing the patients current bone density and help trend the demineralization. This tool is helpful in assessing the patient’s severity of bone loss. This can help the clinician determine the level of treatment to initiate or to modify. This bone density scan can mean the difference between lifestyle modifications and medication treatment. The least screening tool that I perceive to have the least significance is the body mass index. I believe this tool is not the best to assess the patients body composition. Body mass composition is calculated by kilograms divided by the patient’s height in meters squared. Some patients may display more muscle than others and may appear higher in BMI chart. I believe that we need to consider the patients muscle mass before considering any decisions that are based on the patients BMI. Im sure there is a way to improve the bmi calculation incorporating muscle mass. Bmi may work on your average sick patients that may display malnutrition and such. These tools and diagnostic procedures are helpful in guiding the clinician to a diagnosis. None of tools and diagnostics can be used as a stand-alone item to diagnose a patients. We always need a clinician to make a clinical judgement in the diagnostic of a patients problem.