Blogging from the First Stanford Symposium on Bedside Medicine

by Academy of Clinical Excellence on September 25, 2009

I am writing this post from the 'First Stanford Symposium on Bedside Medicine' where I am one of about 50 people who were invited to attend. Other attendees include Dr. Steven McGee (author of Evidence Based Physical Diagnosis), Dr. Lynn Bickley (author of Bates’ Guide to Physical Examination), multiple folks from JAMA who have written or edited the ‘Rational Clinical Exam series’, and various folks representing different national boards.The conference is the brain child of Dr. Abraham Verghese who is a Professor of Medicine, an Infectious Disease specialist, and a noted author. His book, My Own Country, was a finalist for the National Book Critics Circle and his latest book (a novel, Cutting for Stone) has received critical acclaim and is selling well.

I know Abraham from our years working together at the ABIM. He has the best qualities of a priest, rabbi, or other holy man; but his religion is medicine - in general and the bedside exam in particular.

Yesterday, I spoke about our work looking at the role and usefulness of bedside ultrasound as part of the contemporary physicians black bag. Speaking about technology in front of the high priest of traditional bedside exam seemed like the height of effrontery but it actually seemed to go over ‘okay’.

At dinner, Abraham asked that we each come up with 3 ideas to promote teaching of bedside skills. Here are my initial ideas:

#1 - Write a post for the ‘Reflections on Clinical Excellence Blog’ about the conference. It is my hope that the post will stimulate discussion about the bedside exam (history and physical) whether it is truly at the core of clinical excellence. I hope that the Miller-Coulson Academy of Clinical Excellence will develop initiatives to promote it and teaching it. (I can check this one off as ‘done’).

#2 - Establish a fund (perhaps a full FTE) to pay 1-4 senior excellent faculty to spend time observing and teaching every student, resident, fellow and new faculty member performing a history and physical exam. The public would be shocked to learn that most doctors are never observed by a physician instructor and might gladly support such an effort.

#3 – Work with the residency program directors and chief residents to figure out how I can do a better job spending more time during “Chief Rounds” at the bedside--currently it occupies a minority of the time.

Additional thoughts and ideas are welcome.

David B. Hellmann, M.D., M.A.C.P.
Aliki Perroti Professor of Medicine
Vice Dean, Johns Hopkins BayviewMedical Center
Chairman, Department of Medicine
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