The Physical Exam and the Sense of Smell

Throughout medical school, I heard one attending physician after another bemoan the death of the physical examination. “I can read the echo report myself,” a cardiologist once chided me when I detailed the specifics of a patient's tricuspid regurgitation-jet velocity, “but right now I'd like to know what you heard with your stethoscope.” On another occasion, I spent a grueling half hour by the bedside, struggling to answer endless questions from a rheumatologist about a patient's fingernails. During a month with the endocrinology team, I was assigned to simulate hypocalcemia, faking facial twitches and carpal spasms, as my fellow medical . . .