Diagnosing Pneumonia by Physical Examination

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Abstract
INTRODUCED NEARLY 200 years ago, auscultation and percussion of the chest are considered essential in the physical examination and are taught to every medical student.1,2 Although chest physical examination findings can be confirmed with chest x-ray results, objective data on clinician accuracy and reproducibility of physical examination findings are limited. Surprisingly, neither the utility of the physical examination in predicting pulmonary disease nor its value in distinguishing among different pulmonary conditions has been well studied. Furthermore, teachers seldom emphasize the difficulty of eliciting chest physical signs. Increasing constraints on the time available to evaluate patients and ready access to chest radiographs have led clinicians to question the need for a detailed lung examination when lower respiratory infection is suspected. In fact, some believe that auscultation, once considered a sophisticated art that helped guide diagnostic and therapeutic decisions, is "now . . . performed as a bedside ritual."3