For as long as medicine has been practised, great emphasis has been placed on physical examination, both by doctors and patients. Despite the advent of technological aids to diagnosis (TAD) and in particular imaging techniques such as CT, MRI and ultrasound, undergraduate and postgraduate medical education and assessments still include quite extensive evaluation of examination technique and the ability to elicit and diagnose physical signs.

Even though most diagnostic information is gleaned from the clinical history and investigations will proceed in spite of negative physical findings, failure to perform a physical examination is regarded as bad practice both by the profession and by patients (“The doctor didn’t even examine me”).

In a recent clinical review, Elder et al¹ looked at the literature on the value and accuracy of physical examination of the cardiovascular system. While objective comparisons of skilled physical examination with technical evaluation, for example precordial auscultation versus echocardiography, demonstrate the accuracy of physical signs, in practice doctors are losing these clinical skills and increasing their use of and reliance on technology.

Apart from its obvious role in diagnosis, physical examination has some more subtle values. Medicine is one of only a handful of professions involving direct physical contact between the service provider and the client. Sometimes important aspects of the clinical history that have not emerged during the initial interview will be volunteered by the patient during physical examination. Even if the diagnosis could be made without examination, the severity of the illness as evidenced by physical signs may be an important guide to management, both in terms of nature and urgency.

Some research questions that may still need to be asked include:

• Cost effectiveness of strategies that combine physical examination and technological aids to diagnosis (TAD) versus those using TAD alone
• Relation between use of physical examination and use of TAD
• Patients’ attitudes to care strategies, including and excluding physical examination
• Diagnostic error rate in care strategies that include and exclude physical examination
• Diagnostic value of combinations of signs or of signs and symptoms
• Value accorded to physical examination by physicians in contemporary practice
• Diagnostic accuracy of signs of cardiac disease now uncommon in developed countries.

It may also help if medical teachers take a look at conventional instruction on physical examination to ensure that practice is relevant to modern medicine and properly complemented by technology.