The physical examination has been a fundamental aspect of medical assessment for centuries, maintaining its core principles over time. Its aim is to assess patient concerns through observation, palpation, percussion, and auscultation. However, various studies have highlighted the limited diagnostic accuracy, particularly in auscultation, of traditional physical examination methods. Many classic signs and symptoms originated during an era when late-stage disease presentations were more common, potentially leading to missed abnormalities that could have been addressed promptly. Compounding this issue is the recognized decline in doctors' proficiency in performing physical examinations. Consequently, there has been a noticeable surge in requests for radiologic examinations like ultrasound, CT scans, and echocardiograms in recent decades.
However, hospitalized patients are still evaluated using the traditional four elements of physical examination, supplemented by radiological tests to aid in diagnosis. Over the past few decades, there has been a significant increase in requests for radiological exams in healthcare. Data from the NHS reveals 43.3 million imaging requests in a year, and in the USA alone, 70 million chest X-rays are conducted annually. Additionally, over seven million echocardiograms are requested annually in the USA. Despite many of these scans showing negative results, they contribute to healthcare and hospitalization expenses, which could be challenging to sustain in capitated healthcare systems or resource-constrained countries.
Point-of-care ultrasonography (POCUS) is a limited ultrasound examination performed by clinicians to address specific clinical queries at the patient's bedside. It has emerged as a valuable supplement to the physical examination. POCUS-enhanced physical examination became part of emergency and critical care practices a couple of decades ago with the introduction of E-FAST and BLUE protocols. These protocols were developed to assess undifferentiated shock or breathing difficulties in patients requiring urgent care.
