Where has all the pimping gone?
Clinical examination is a dying art.
Just spent another frustrating shift attempting to admit a patient with acute appendicitis (clinically) – without a CRP, ultrasound scan, CT scan or a tattoo on their forehead saying “I have acute appendicitis”
Thought it appropriate to share a clip from the olden days…
“Eyes first & most, hands next & least, & tongue not at all”
“To be a successful surgeon – you need the eyes of a hawk, the heart of a lion and the hands of a lady”
Sir Lancelott Spratt
Life in the Fast Lane Pimping Posts
About Mike Cadogan
Great film.
At least the surgical attitude hasn’t changed… Even if it is impossible these days for them to examine prior to imaging.
Love the matter-of-fact condescension to the patient -- “this is nothing to do with you”.
I miss that era of surgeons from my intern years who prided themselves on diagnosis by history and exam. Imaging has a role of course, but is there any surgical diagnosis that doesn’t score some sort of imaging -- e.g. US for an abscess. Appendicitis is well known to be primarily a clinical diagnosis -- however it is heading the way that surgeons seem to want every test possible -- is it now a diagnosis of exclusion?
When I know the surgeon is coming to see my kiddos with appendicitis I saw on ultrasound I play the trick -- “oh wow -- you already came? I am just finishing the scan -- LOOOOOK HERE IT IS”… Slowly but surely they are learning
It’s how you can tell the good surgical reg from the inexperienced -- a good one is happy to sit on the undifferentiated young female (or male) with abdominal pain and some mild signs, and observe, without diving into a scan. I for one refer and wait for review and admit under surg, if I don’t believe a CRP or scan is warranted until they see the patient. Let them fry the patient!
This is so very true. The only thing to add to this is that I like the US for young women in the vain hope that some gynaecological pathology will reveal itself.
You only need one horror case to be switched onto scanning though -- for me it was assisting in the Hartmann’s reversal of a young man who had his nasty diverticulitis excised through a very very very extended McBurney’s incision -- apparently it was clinically appendicitis and the decision was made to proceed to an open appendicectomy with disastrous consequence.