Des, I wholeheartedly agree with your opinion that the use of ultrasound should be more widespread and, in the era of pocket echos, the days of using the stethoscope for listening to heart sounds may be numbered. But I have to say I disagree with your bleak assessment of the value of physical examination.

In my opinion, improving physical examination skills can only reduce the burden of investigation because it is when we are most uncertain that we cast off on the fishing expeditions of scatter gun investigations.

If nothing else the physical exam is a form of communication, it’s a way of demonstrating to the patient that you are taking them seriously and looking more deeply into their complaint. And, if you’re going to do it for that reason, you may as well be trained to make it of some diagnostic value as well.