Bravo to Dr. David Robbins for his article in the October 2008 issue titled "Leading Off: Why the physical exam is still really necessary." I could not agree with him more. As a surgeon in a referral practice, I see cases that have not been thoroughly worked up, thus missing conditions that could have been identified with a complete physical examination, using only the five senses and basic equipment. I am delighted that we have ultrasound, CT, MRI, and other noninvasive diagnostic tools, but they should always be used as an adjunct to a less costly physical exam. In today's economic times, we may see that we are forced to practice without some of these expensive tools.

Another area in which we often forget to use our senses is in anesthesia monitoring. Don't get me wrong—we use pulse oximeters, CO₂ monitors, ECG monitoring, blood pressure monitoring, and temperature monitoring in every patient, but a lot of valuable information can be obtained by using an esophageal stethoscope and by assessing capillary refill time, pulse quality, jaw tone, etc. The point being that we should use all the tools available to us!

Again, I applaud Dr. Robbins for bringing this matter to our attention. I would encourage professional schools to re-emphasize the art of physical examination.