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The importance of the history and physical in diagnosis

doi: 10.1097/01.NPR.0000445726.93236.5e
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INSTRUCTIONS The importance of the history and physical in diagnosis


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The importance of the history and physical in diagnosis

General Purpose: To identify the importance of the patient history and physical in selecting diagnostic testing and in reaching an accurate diagnosis. Learning Objectives: After reading this article and taking the test, you should be able to: 1. Describe common pitfalls in the clinical evaluation process. 2. Identify strategies for increasing the accuracy and reducing the cost of diagnosis.

  1. The author asserts that broad testing strategies
    1. are increasingly important as visit times become shorter.
    2. are vital for confirmation of diagnoses.
    3. may provide less information than the history and physical.
    4. are important to reduce healthcare costs.
  2. Which patient issue often complicates the clinician visit?
    1. rising healthcare costs
    2. bringing multiple concerns
    3. shorter visit times
    4. greater volume of visits
  3. In the clinical evaluation process, which is the first step to an accurate diagnosis?
    1. advanced physical exam skills
    2. scheduling longer visit times
    3. refining the art of the history
    4. requiring patients to complete detailed history forms
  4. Which approach will best help the provider determine the cause of a patient's dizziness?
    1. reviewing the detailed history form
    2. asking if he or she feels faint or anxious
    3. asking the family about unsteady gait or behavioral changes
    4. asking the patient to describe what he or she means by “dizzy”
  5. Which statement about comprehensive history taking is not accurate?
    1. It will elicit the correct diagnosis less than 50% of the time.
    2. It may be more efficient than ordering diagnostic studies.
    3. It is a reliable diagnostic tool.
    4. It requires the clinician to listen to the patient.
  6. Research by Beckman and Frankel demonstrated that patients and providers may not agree on the purpose of the visit because of
    1. incomplete information on the previsit survey form.
    2. family members' input to the provider contradicting the patient's.
    3. providers interrupting patients.
    4. patient unwillingness to disclose the real reason for the visit.
  7. Asking the patient whether there is something else they want to address in the visit would
    1. best be done at the end of the visit.
    2. increase the length of the visit.
    3. eliminate all unmet concerns.
    4. help to construct an appointment agenda.
  8. One approach to help elicit the patient's concerns is to
    1. have the patient complete an extensive health history form.
    2. extend the length of the visit.
    3. ask an open-ended question.
    4. involve a family member during the visit.
  9. The best reason for conducting a thorough physical exam is to
    1. reduce the number of diagnostic tests.
    2. reach an accurate diagnosis faster.
    3. reduce the list of potential diagnoses.
    4. confirm the patient history.
  10. Ordering too many diagnostic tests is a stressor to providers and patients when they result in
    1. large medical bills.
    2. lab results not supporting the provisional diagnosis.
    3. unexpected positive findings that cannot be ignored.
    4. test results all being normal.
  11. Which statement relating to diagnostic accuracy is supported by the literature?
    1. Diagnostic studies should not be used to rule out a diagnosis.
    2. Basing diagnostic studies on the history and physical is cost-effective.
    3. An accurate diagnosis can be confirmed only by diagnostic testing.
    4. Diagnostic testing results always support a thorough history and physical.
  12. When providers rely on imaging scans rather than their exam skills to make a diagnosis, they
    1. risk losing physical exam skills.
    2. increase diagnostic accuracy.
    3. detect pivotal physical signs more accurately.
    4. save time and reduce costs.
  13. Evidence-based practice studies have shown that
    1. physical exam skills are ineffective in preventing disease.
    2. eliminating annual physical exams is important only in young adults.
    3. diseases can be detected best with diagnostic testing.
    4. certain physical signs are unreliable.
  14. The Top 5 list consists of
    1. the most commonly ordered tests.
    2. a list of procedures to avoid.
    3. the most common patient complaints.
    4. the most commonly missed diagnoses.
  15. What is the first step in helping patients become active participants in their own care?
    1. discussing recommended interventions with the patients
    2. sharing information with patients
    3. involving patients in decision making about diagnostic tests
    4. eliciting a comprehensive patient history


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