Clinical Excellence Pearl from Medical Grand Rounds

by Academy of Clinical Excellence on January 16, 2013

The history and physical examination is a time-honored aspect of the medical encounter whose benefits have been highlighted in countless articles in the medical literature.  At today’s Grand Rounds, we heard from a healthy young woman who works in health care like almost everyone in the audience, and like most of those in attendance, drinks several cups of caffeinated coffee every day.  When she developed severe and increasingly bothersome palpitations, she went to an urgent care facility and was referred to a cardiologist.  The cardiologist told her to cut down on caffeine.  She found that recommendation challenging to follow, as many in the audience probably would have, and her palpitations became even more severe.  One day while at work in the hospital, she felt particularly poorly and a colleague suggested she see a cardiologist here.  The striking feature of the history was how bothersome the palpitations were, prompting the patient to see two cardiologists in just a few months despite being the type of person who did not have a tendency to go to doctors much at all.  The striking feature of the physical examination was fixed splitting of the second heart sound, which strongly suggested that the patient had an atrial septal defect.  The utility of the history and physical examination as a means of determining the likelihood that serious heart disease underlies a fairly common symptom (like palpitations) was discussed.  


- Roy Ziegelstein, MD, MACP

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swright January 18, 2013 at 2:33 pm

A clinical excellence nugget that I took away from this excellent talk:

The young woman explained that she expected to leave Dr. Ziegelstein's office being told that nothing was wrong but instead she learned that she had a defect in her heart that needed to be fixed surgically. In spite of this unwelcomed surprise, the patient recounted feeling "very comfortable" when leaving his office because of the time spent with her, the clear communication, and the doctor's humanism.

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