history and physical

Chief Complaint Portion of History and Physical Found to be “Utterly Useless”

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CHICAGO, IL – A new study released by the American Medical Association today finds no validity to the “chief complaint” portion of the standard history and physical.  The primary outcome measured was the correlation between the written chief complaint and the final assessment.

history and physicalThe study consisted of a cross-sectional sampling of over 50,000 history and physical exams performed across all types of medical facilities, from walk-in clinics and urgent care centers to tertiary care hospitals and research facilities.  The study also grouped chief complaints by who took them and their level of education, i.e. medical students vs. attendings.

A few trends were noted in the study.  Medical students and office staff tended to give either overly long or overly short chief complaints, essentially, a bimodal distribution.  One such example of a long complaint, “I’ve been having scrotal swelling for the past three months because I have babesiosis.  My symptoms matched what I read on Google.”  In this case, the final plan consisted of giving the patient drops to loosen cerumen.  Short complaints usually consisted of zero (blank chief complaint) to two words (dead leg).  In the latter case, the patient’s “dead leg” was a lost prosthesis that was ultimately found in another patient’s belongings.

At the opposite end of the spectrum, residents and attendings tended to omit the chief complaint altogether, however, when they were pressed to give one, based it on the final diagnosis.  On the residents’ part, this was due to forgetting to take a chief complaint in the first place, and on the attendings’ part, was related to the ability to bill for the visit.

In the end, despite multivariate and subgroup post-hoc analysis, no correlation between chief complaint and final assessment and plan could be found.  Says Amit Patel, MD, principal investigator for the study, “We’ve suspected such a finding for some time now, but now we have good objective evidence for omitting the chief complaint altogether.  This will vastly change our approach to teaching how to take history and physicals in the future.”

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