Original Article

The Value of Physical Examination: A New Conceptual Framework

Authors: Junaid Zaman, MA, MD, Abraham Verghese, MD, Andrew Elder, MD


The physical examination defines medical practice, yet its role is being questioned increasingly, with statistical comparisons of diagnostic accuracy often the sole metric used against newer technologies. We set out to highlight seven ways in which the physical examination has value beyond diagnostic accuracy to reaffirm its place in the core skills of a physician and guide future research, teaching, and curriculum design. We show that this more comprehensive approach to the physical examination of its “utility” beyond that of reaching a diagnosis can be beneficial to both doctor and patient.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Verghese A, Brady E, Kapur CC, et al. The bedside evaluation: ritual and reason. Ann Intern Med 2011;155:550-553.
2. Verghese A, Charlton B, Cotter B, et al. A history of physical examination texts and the conception of bedside diagnosis. Trans Am Clin Climatol Assoc 2011;122:290-311.
3. Tavel ME. Cardiac auscultation. A glorious past-but does it have a future? Circulation 1996;93:1250-1253.
4. Roelandt JR. The decline of our physical examination skills: is echocardiography to blame? Eur Heart J Cardiovasc Imaging 2014;15: 249-252.
5. Vukanovic-Criley JM, Criley S, Warde CM, et al. Competency in cardiac examination skills in medical students, trainees, physicians, and faculty: a multicenter study. Arch Intern Med 2006;166:610-616.
6. Verghese A, Charlton B, Kassirer JP, et al. Inadequacies of physical examination as a cause of medical errors and adverse events: a collection of vignettes. Am J Med 2015;128:1322-4.e3.
7. McGee S. Evidence-based Physical Diagnosis. 3rd ed. Philadelphia:WB Saunders , 2012.
8. Simel DL, Rennie D, Keitz SA, (Eds). The Rational Clinical Examination: Evidence Based Clinical Diagnosis. New York:McGraw-Hill , 2008.
9. Elder A, Japp A, Verghese A. How valuable is physical examination of the cardiovascular system? BMJ 2016;354:i3309.
10. Armstrong DW, Tobin C, Matangi MF. Accuracy of the physical examination for the detection of lower extremity peripheral arterial disease. Can J Cardiol 2010;26:e346-e350.
11. Cournot M, Boccalon H, Cambou JP, et al. Accuracy of the screening physical examination to identify subclinical atherosclerosis and peripheral arterial disease in asymptomatic subjects. J Vasc Surg 2007;46:1215-1221.
12. McGee S. Etiology and diagnosis of systolic murmurs in adults. Am J Med 2010;123:913-921.e1.
13. Caldentey G, Khairy P, Roy D, et al. Prognostic value of the physical examination in patients with heart failure and atrial fibrillation: insights from the AF-CHF trial (atrial fibrillation and chronic heart failure). JACC Heart Fail 2014;2:15-23.
14. Minami Y, Kajimoto K, Sato N, et al. Third heart sound in hospitalised patients with acute heart failure: insights from the ATTEND study. Int J Clin Pract 2015;69:820-828.
15. Lala A, McNulty SE, Mentz RJ, et al. Relief and recurrence of congestion during and after hospitalization for acute heart failure: insights from Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARESS-HF). Circ Heart Fail 2015;8:741-748.
16. Lucas C, Johnson W, Hamilton MA, et al. Freedom from congestion predicts good survival despite previous class IV symptoms of heart failure. Am Heart J 2000;140:840-847.
17. Ambrosy AP, Pang PS, Khan S, et al. Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial. Eur Heart J 2013;34:835-843.
18. Cheraghi-Sohi S, Hole AR, Mead N, et al. What patients want from primary care consultations: a discrete choice experiment to identify patients’ priorities. Ann Fam Med 2008;6:107-115.
19. Kadakia KC, Hui D, Chisholm GB, et al. Cancer patients’ perceptions regarding the value of the physical examination: a survey study. Cancer 2014;120:2215-2221.
20. Elder AT, Verghese A. Bedside matters-putting the patient at the centre of teaching and learning. J R Coll Physicians Edinb 2015;45:186-187.
21. Wu EH, Fagan MJ, Reinert SE, et al. Self-confidence in and perceived utility of the physical examination: a comparison of medical students, residents, and faculty internists. J Gen Intern Med 2007;22:1725-1730.
22. Rothberg MB. A piece of my mind. The $50,000 physical. JAMA 2014;311:2175-2176.
23. Bergl P, Farnan JM, Chan E. Moving toward cost-effectiveness in physical examination. Am J Med 2015;128:109-110.
24. peer60. Unnecessary imaging: up to $12 billion wasted each year. http://research.peer60.com/unnecessary-imaging. Accessed September 21, 2016.
25. National Academies of Sciences, Engineering, and Medicine. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press, 2015.
26. Eisenberg MJ, Afilalo J, Lawler PR, et al. Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction. CMAJ 2011;183:430-436.
27. Elder A, Chi J, Ozdalga E, et al. A piece of my mind. The road back to the bedside. JAMA 2013;310:799-800.