The Importance of the Cardiorespiratory Physical Examination

Most practicing health care providers agree that “a good physical exam can save lives by rapid diagnosis and treatment…”. However, with the advancements of technology, providers today have many tools at their fingertips to help diagnose a patient that presents with just about any symptom. And, although physical examination is still an important part of patient care, “the decline of physical exam skills in the new generation of physicians is a well-documented phenomenon.”¹ 

Emphasis is often placed on the availability of technology rather than exemplary physical examination.  “In the era where medical technologies advance rapidly, one may think that savvy medical diagnostics such as echocardiography or cardiac CT-scan can replace a thorough cardiac exam readily. But one must remember, a combination of a comprehensive history and detailed cardiac exam can diagnose almost 80% of cardiac disease.”¹

The same statements have been said about the respiratory physical exam. “Due to the close relationship with nearby structures such as the heart, great vessels, esophagus, and diaphragm, a careful examination of the lungs can provide clues towards a diagnosis.”² As part of the whole chest exam, “auscultation of the lung still provides valuable, immediate and low-cost information to the experienced clinician.”²

Obtaining and maintaining good physical exam skills for both heart and lungs has many advantages:

• “The 4 major components of the lung exam (inspection, palpation, percussion, and auscultation) are also used to examine the heart and abdomen.”³
• Some patient complaints (such as shortness of breath on exertion) could mean either significant cardiac or pulmonary dysfunction.
• Patients with significant lung disease (such as COPD) may have very soft heart sounds, requiring a change in the patient’s position to best hear the heart sounds.
• “Auscultation is a difficult skill to ‘master’”.³

So, are the best practices of patient care and diagnosis being reversed because of technology?  When discussing the clinical significance of obtaining and maintaining good physical examination skills, the National Institute for Medicine states, “clinicians must be proficient in these skills to develop differentials and THEN order tests to confirm or refute differentials. Many diseases can be diagnosed solely based on good history taking and physical exam skills… Furthermore, the physical contact between the clinician and the patient during an encounter can also help create a psychological bond that provides reassurance and generates trust.”¹

But learning these skills is not just for providers. “All healthcare workers should know how to perform a physical exam. In the inpatient setting, the cardiac exam should be a part of routine history and physical during admission and should be done daily. In the outpatient setting, the cardiac exam is still the most appropriate method to screen for cardiac disease and establish a diagnosis.”¹

An article in the National Library of Medicine states, “Several recent studies have described a deterioration in physical examination skills among modern physicians. Reasons hypothesized for this change are improvements in technology and time constraints. Poor physical exam skills are a noteworthy threat to patient safety as they can lead to incorrect as well as missed diagnoses, causing delays in timely implementation of life-saving treatments.”⁴

Limbs & Things is proud to introduce the Cardiac and Respiratory Examination (CaRE) training model. With more technology than has ever been included in our products, this realistic and comprehensive trainer enables healthcare professionals of all levels to train confidently in identification and diagnosis of respiratory and cardiology pathologies.  With over 31 cases, many patient co-morbidities can be created that mimic real-life scenarios.

¹ Cardiac Exam: NIH

² Lung Exam: NIH

³ Practical Guide to Clinical Medicine

⁴ Importance of Thorough Physical Exam: A Lost Art