The Stanford 25

Not only does the physical examination establish a connection between doctors and patients, it is part of a continuum linking them to clinicians of the past — clinicians whose names are enshrined in physical signs they were the first to describe.

But physical examination is under threat. Medical practitioners of the 21st century work in an increasingly time-poor environment. Gone are the days when clinicians were respected for the skill they brought to the bedside. The emphasis these days is on how many tests can be performed!

This threat to the physical examination recently prompted clinicians at the Stanford School of Medicine to develop the “Stanford 25” — a list of 25 technique-dependent, physical diagnostic manoeuvres that are now mandatory for trainees to learn. These include such basics as fundoscopic examination, pupillary reflexes, examination of the thyroid, liver and spleen, and elucidation of ankle reflexes in a recumbent patient.

All this takes me back some 30 years, when, as a research fellow at Duke University Medical Center in North Carolina, one of my tasks was to teach a semester devoted to clinical examination. Only then did I realise how well Australian physicians are grounded in the art of clinical examination throughout our undergraduate and postgraduate years. The skills imparted to us were light-years ahead of those learned by our counterparts in the United States. Even today, it is easy to distinguish the US from the Australian graduate by the latter’s confidence and expertise in the skills of clinical examination. Let us hope that this continues, and we need never resort to protocols such as the Stanford 25.