Background Physical examination is an indispensable skill in the art of medicine which, together with history taking, enables physicians to achieve a clinical diagnosis. Previous studies have consistently shown wide variations in the documentation of physical examination findings on systemic review (1,2). In particular, musculoskeletal examination was found to be frequently omitted.
Objectives The aim of this study was to evaluate the quality of junior doctors' medical admission clerking, with a focus on clinical examination.
Methods Fifty acute medical admission clerking entries by junior doctors in a university hospital were reviewed. Case notes were assessed for clinical details and physical examination performed.
Results Mean age was 69. The commonest presenting complaint was fall or collapse. Musculoskeletal examination was only documented in 24% of admitted patients. There was disparity in the quality of documentation, ranging from complete omission to comments such as “valgus deformity”, “erythema”, “limited abduction” and “unable to SLR”. Overall, the documentation of cranial nerves examination, limb neurological examination, abbreviated mental test and Glasgow coma scale was less robust (40%, 52%, 48% and 66% respectively). The documentation of musculoskeletal and neurological examination contrasts markedly with other systems: respiratory system 100%, cardiovascular system 98% and abdominal system 98%.
Conclusions The omission of musculoskeletal examination may reflect a general apathy towards musculoskeletal health. Despite fall or collapse being the most common reason for medical admission in this study, musculoskeletal examination was only documented in a minority of patients. With an aging patient population, it is vital for physicians to address musculoskeletal disorders which are likely to be more prevalent on the acute medical take. Junior doctors' lack of confidence in performing musculoskeletal examination may also be another contributing factor. It is important that junior doctors are provided feedback on their clinical assessment by senior doctors when essential components of examination are omitted. National training programmes should consider including these areas in postgraduate curriculum to ensure competency is achieved.
) Doherty M, Abawi J, Pattrick M. Audit of medical inpatient examination: a cry from the joint. J R Coll Physicians Lond 1990;24(2):115–8.
) Myers A, McDonagh JE, Gupta K, et al. More “cries from the joints”: assessment of the musculoskeletal system is poorly documented in routine paediatric clerking. Rheumatology (Oxford) 2004;43(8):1045–9.
Disclosure of Interest None declared