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- Page navigation anchor for RE: The annual history and physical has actually bee dead for decadesRE: The annual history and physical has actually bee dead for decades
When I was a medical student at McGill in the 1970s, I was overwhelmed by the conflicting recommendations from various services to include specific questions and investigations in the complete exam - so overwhelmed that I took a 3 month sabbatical in third year to explore this subject.
This resulted in a paper in the CMAJ (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1947878/) which challenged the conventional model of the "complete history and physical" and recommended two things: 1) selective examinations, based on the reason for the patient presenting, and 2) getting to know the patient as a person, in all her or his rich complexity.
A few years later, the Canadian Task Force on the Periodic Health Examination was formed, and in 1979 it published its report, which concluded that "the Task Force's main recommendation is, therefore, that the routine annual check-up be abandoned in favour of a selective approach that is determined by a person's age and sex." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1704686/?page=2
The reason the annual check-up has persisted for nearly 4 decades since these findings were first shared reflects the often convention-ridden and protocol-oriented core of much medical practice, embedded in a fee-for-service system that rewards many short visits and...
Show MoreCompeting Interests: None declared. - Page navigation anchor for Think and practice reflectivelyThink and practice reflectively
Dear Editor,
I congratulate Dr. Roger Ladouceur for his reflective editorial in the January 2018 issue of the Canadian Family Physician, which I absolutely support [1]. Thinking and practicing scientifically means primarily asking questions or questioning them, whereby the new cannot be understood, judged and used without the old. Today, the founder of the systematic anamnesis Rufus of Ephesus (c. 80 - 150 AD) would probably ask in connection with the handling of clinical recommendations in medical practice: How and to what extent are patients' preferences taken into account in the conceptual process of preparing a clinical recommendation? [2, 3] Do we have a one-size-fits-all mentality in the recommendations or enough flexible room for physicians to tailor care to the patient's personal circumstances and medical history? What concrete procedures should be used to create practice-oriented and usable guidelines? Today, the Greek physician Rufus would agree with Dr. Ladouceur: many guidelines are not properly developed [1].
Almost 20 years ago, an attempt was made to find out what potential barriers to physician guideline adherence could exist: lack of awareness and lack of familiarity (volume of information, time needed to stay informed guideline accessibility), lack of agreement with specific guidelines or guidelines in general, lack of self-efficacy, lack of outcome expectancy, lack of motivation/inertia of previous practice (habit, routines), and...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Annual physicalRE: Annual physical
I so agree. I have been a doctor for 45 years and have never picked up anything of value on an annual physical. It was good for giving us time for talking to the patient and getting paid appropriately.
Doing a BP on everyone is a much better thing to do as it is symptomless.Competing Interests: None declared.