Clinical Skills in the 21st Century

James T. C. Li, MD, PhD
Arch Intern Med. 1994;154(1):22-24. doi:10.1001/archinte.1994.00420010030005.
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A PHYSICIAN intends to examine the spleen of a patient. She approaches the patient tentatively; her eyes move left, then right. Finally she palpates the right upper quadrant of the patient's abdomen, searching in vain for a spleen tip.

A physician intends to measure the blood pressure of a patient. She unhooks the blood pressure cuff from the wall of the examining room, examining it quizzically. She wraps it around the upper arm of the patient (inside out), perhaps realizing something is not right. The physician pumps up the cuff with the black rubber bulb—the cuff expands like a balloon, ripping apart the hook-and-loop (Velcro) closure. The cuff falls uselessly, half-inflated, by the examining table. Despite several further attempts, the physician is unable to correctly place the cuff on the patient's arm.

Are these fanciful examples of futuristic physicians, well versed in high technology but incompetent in physical examination? No,


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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