Usefulness of Physical Examination in Detecting the Presence or Absence of Anemia-Reply

In Reply. —We would like to reassure Dr Sapira that our intent in evaluating the usefulness of the presence or absence of pallor in predicting anemia was not to demean the importance of the physical examination.¹ Rather, it was an attempt to bring the principles of medical decision analysis into the bedside domain of physical diagnosis. Whereas the value of physical examination has been passed from one generation of clinicians to another, it is now a revered skill under scrutiny.²

Tests of physical diagnosis must be evaluated with the same scientific rigor as all laboratory tests. In this study we set out to determine the operating characteristics of five physical examination observations. Our data indicated that inspection of the conjunctivae, face, and palms were superior observations and better predictors of anemia, or lack thereof, than examination of the nailbeds. Furthermore, the common belief that palmar creases are indicative