I have tired of treating my ultrasound exam of a patient as separate from my physical exam. In the emergency department and ICU where I practice, ultrasound is much more than an adjunct, it is an integral part of my evaluation of the patient.

The JAMA series on Rational Clinical Examination has taught us that each physical exam maneuver needs to be evaluated with an evidenced-based assessment, that includes sensitivity and specificity. We have learned through the series that many specific exams are near worthless, while others provide some value though far less than we may have been led to believe during our medical school and residency training.

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The knowledge of the fall failings of the traditional physical exam, and the near universal availability of bedside ultrasound has changed the physical exam fundamentally and forever. Many previous exam maneuvers such as palpating ventricular heave or PMI, are distant markers of what you fundamentally care about which is cardiac function. With ultrasound that gives you direct visualization of structures, ventricular function can be directly interpreted even by novice registrars.

A stethoscope, reflex hammer, or pen light are tools that aid my physical exam. Ultrasound is just another tool, that quickly an easily lets me answer questions during my physical. There is nothing that feeling for abdominal bruits can tell me that cannot be more quickly and more definitively answered with an abdominal probe in your hand.

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