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Physicians launch study on oversights in the physical exam

Abraham Verghese, MD, and colleagues have launched an unusual study examining oversights in the physical exam. In the study, Verghese is asking physicians far and wide to fill out an online survey and to pass it on to friends, co-workers and colleagues who might have an interest in completing the questionnaire. So far Verghese has collected 140 responses and hopes to rapidly grow this number. Below he discusses the focus of the study, motivation for conducting the survey and how the results hold the potential to advance bedside medicine.

What is the focus of the study?

We are interested in looking at a type of medical error that is poorly studied. Unlike wrong-site surgery or medication error, oversights in the physical exam that have consequences are not easily quantified. We believe that narratives or anecdotes of such incidents, when collected in numbers, are the best way to capture this phenomenon. By collecting these anecdotes we can then analyze and characterize the nature of such oversights and their consequences. Our study has approval from the Institutional Review Board Services.

What prompted you and colleagues to launch the study?

We have a sense that studies on "medical errors" wind up focusing on obvious and easily documented things like wrong site surgery or medication error. The error we focus on we think is both common and increasing as people depend more on tests than on talking to or examining the patient. It has also been an opportunity for me to collaborate with four outstanding colleagues each with special expertise in related areas, but all of sharing a passion for this subject. The others are: John Ioannidis, MD, DSc, Meghan Ramsey, MD, Ralph I. Horwitz, MD, MACP and Jerome P Kassirer, MD, MACP.

How will the findings benefit patient care or advance bedside medicine?

It's tough to predict the results ahead of time. But just like the famous Institute of Medicine report "To Err is Human," which pointed out the magnitude of medical error, we hope a study like this might also surprise the public and physicians alike with a kind of medical error thus far hidden. It might be an incentive to perhaps creating a high stakes practical examination to establish that physicians have the necessary skill to make simple diagnosis at the bedside. At present, you can graduate medical school and be board certified in this or that specialty without anyone really having observed you feel a spleen or detect a rash or detect a breast mass or cancerous lymph node. We make assumptions about that sort of thing, and it is clear that we are missing many obvious things. We get away with it because without collecting anecdotes like this, one would never know.

Previously: Examining the unspoken clues exchanged between patients and doctors, Stanford’s Abraham Verghese discusses the power of touch and observation in the exam roomImproving communication between doctors and patients and Working to improve patient-doctor communication

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