Evaluation of the physician's ability to recognize the presence or absence of @entity417 , XXXX , and @entity1087 .

@entity1 @entity1087 @entity417 @entity648 @entity2613 @entity221
OBJECTIVE: The evaluation of the @entity1 through a comprehensive history and physical examination is considered the cornerstone of medical diagnosis, but many studies suggest that physicians have inadequate physical examination skills. It is unknown whether these skills are reliable and whether they can be adequately acquired through training. The objective of this study was to evaluate the ability of the clinician to detect the presence and discriminate the extent of clinical @entity417 , @entity221 , and @entity1087 in an @entity2613 or hospitalized @entity1 . METHODS: This was a prospective observational study of a convenience sample of @entity1 presenting to the @entity2613 or admitted to the hospital who had a rectal temperature measurement within 30 minutes prior to the observation, serum hematocrit measurement on the day of observation, or serum @entity648 measurement one day prior to the day of observation. Observers' (emergency medicine attending physicians', resident physicians', and rotating medical students') estimated serum hematocrit, rectal temperature, and serum @entity648 values were obtained after each observation. Sensitivity, specificity, positive predictive value, negative predictive value, and mean absolute difference between actual and estimated values were calculated for each observer. RESULTS: The physicians detected the presence or absence of @entity417 , @entity221 , and @entity1087 in @entity1 with sensitivities and specificities of approximately 70%. Their predictions varied from the measured value on average by 6.0 +/- 4.6% for serum hematocrit, 1.3 + 1.1 degrees F for rectal temperature, and 3.4 +/- 5.3 mg/dL for serum @entity648 . Observer accuracy decreased when evaluating @entity1 with high and low measured values. CONCLUSIONS: The ability to correctly perform and interpret the physical examination appears to be independent of the observer level of training, @entity1 ethnicity, or @entity1 gender. The examination for pallor, warmth, and @entity1087 is unreliable in predicting the corresponding laboratory or electronic measurement. Certain anemic, febrile, or @entity1087 @entity1 may not be reliably detected solely by a focused physical examination.
