According to a review published online on 4 August in the Annals of the American Thoracic Society, little or scarce data on the advantage of bedside physical examinations in the ICU (intensive care unit) are available.
Having examined the utility of bedside diagnosis in modern ICU practice, the authors of this review, Dr. Thomas S. Metkus and Dr. Bo Soo Kim from Johns Hopkins Hospital, Baltimore, report that bedside evaluation and physical examination are used heterogeneously at cross-institutional level. Opinions regarding the profit of the physical assessment in the ICU are divergent, with some pointing out its value in terms of diagnostics and in enhancing the patient-doctor relationship. Little to support the profit of physical examination in the ICU has been published to this date. Moreover, some data show that test features of specific physical examination maneuvers are substandard, whilst other indicate that specific physical findings can have a clinical impact. No standardisation when it comes to bedside diagnosis in the ICU exists so far and there is no agreement as to which physical examination maneuvers are useful, who should conduct such exams, and in which cases they are to be performed.
“The bedside ‘laying on hands’” the authors argue in favour of the advantage of bedside physical examination “provides a humanizing and grounding counterpoint, for patients, families, and physicians and providers alike, to the dehumanizing effects of critical care and high-technology, high-intensity medicine”.
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