Michael S. Gordon, M.D., Ph.D - University of Miami

5-Fingers of Cardiovascular Evaluation

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The bedside examination is best carried out in the context of the overall patient evaluation. The overall patient evaluation includes very importantly, the history, then the physical exam or bedside examination, then low-cost - high yield procedures, traditionally, the electrocardiogram, the chest X ray, the echocardiogram and finally last, invasive procedures such as angiography, catheterization, and so forth. The bedside examination is critically important and we shall cover that shortly, but I would like to emphasize that first finger, the history, is also extremely important.

It isn't important just because it directs you toward the patient's complaints, but it is also important because it gets you to understand the kind of human being with whom you are dealing. In the words of the most quotable physician who ever lived, Sir William Osler, "you not only have to know what kind of disease the patient has, you also have to know what kind of patient the disease has." many times, clinical judgments are made in the context of patient’s concerns, problems, items that are involved in their personal life and, hence, we must understand the patient totally to properly care for them.