Why do most of us dread patients who complain of dizziness in the ED? Because it is so vague, and the differential is so broad from elusive posterior cerebellar strokes to ear wax clogging up our ear canals. And this is one of those diagnoses where the differential really depends upon performing a thorough physical examination.
Think really hard, when is the last time you focused upon getting a complete and accurate physical examination? In medical school, there are courses dedicated to the art. I always laugh when I think of my neurology attending who just loved to bang on different parts of the body with his reflex hammer to elicit cool reflexes.
Then comes the real world! Sure, we can see a waiting room full of patients on a busy day. But this is without writing a single note, not taking a bathroom break, and barely talking to consults. What, I wonder, could possibly be the accuracy of my physical exam findings during those days? Could we be missing important findings by skipping time consuming things such as pelvic exams?