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“In the past 25 years, I have taught hundreds of medical students the four classic steps in the physical examination: inspect, palpate, percuss, and auscultate. Their eyes sparkle. This is the way they imagined themselves: semioticians at the bedside, reading the signs to find the varmint in the patient’s body. Alas, a shock awaits the students when they finally arrive on the wards in the third year of medical school, their pockets laden with reflex hammers, tuning forks, ophthalmoscopes, otoscopes, penlights, and stethoscopes, only to discover that the ebb and flow of the modern hospital centers on MRIs, CAT scans, echocardiograms, angiograms, and myriad lab tests. Often, interns and residents have so little faith in bedside diagnostic skills that, as one student told me, ‘a man with a missing finger must get an X-ray before anyone will believe he has only four.’…
