Evidence–based physical examination and point-of-care testing to improve patient care and avoid unnecessary hospital admission

I very much appreciate the article by Cals and Ebell.¹ Evidence–based physical examination and an accurate history taking can lead in up to 77–90% of cases to a patient’s diagnosis,² but there are limitations to history taking and clinical signs on physical examination. The clinical assessment of renal failure is limited and two-thirds of acute kidney injury identified in hospital started in the community with a high mortality.³ Identifying renal impairment by an eGFR analyser or urgent blood test (biomarker) via a domiciliary phlebotomist or specimen transport can potentially reduce disease progression and hospital admission, which applies to abdominal pain as well.⁴

The clinical evaluation of abdominal pain can be limited, as no finding on clinical examination can effectively rule out appendicitis.⁵ The Alvarado clinical decision model is recommended as the most user-friendly while being among the most powerful, but it incorporates biomarkers.⁶ Further research has to be undertaken into the value of biomarkers in the diagnostic reasoning process and its application and availability in the GP setting.^7,8 Knowledge of the accuracy and limitations of the physical examination in the diagnostic process by introducing teaching of evidence-based physical examination in the undergraduate curriculum and postgraduate education and introducing point-of-care testing in the future are needed, in order to improve patient care and make it more cost-effective and patient friendly.⁹