Handheld ultrasound and diagnosis of cardiovascular disease at the bedside.

I n 1903, Dr. William Osler advocated for reform of medical education to emphasize bedside teaching, recommending “no teaching without a patient for a text and the best teaching is that taught by the patient himself” (1). More than a century later, new voices in the profession echo that sentiment, suggesting that diagnosis has again strayed from the bedside. Some propose that technology has usurped the clinical examination at the expense of patient care and the cognitive development of practitioners. Proponents of bedside medicine lament that ward rounds have been reduced to examining a patient’s electronic medical record and clicking computerized order sets based on results of myriad prior diagnostic tests. Inspection of jugular venous pulsations, palpation of the precordium, and auscultation of heart tones are multisensory experiences that require the physician to integrate observation, touch, and hearing in the context of the patient’s clinical history and symptoms. The medical history provides a framework for developing a logical differential diagnosis. For example, in evaluation of chest pain syndromes, a thorough history characterizing the quality, severity, location, duration, and tempo of symptoms can guide diagnosis, risk stratification, and management. Incorporation of Bayesian theory can enhance diagnostic accuracy based on rational statistical inference, thereby increasing the predictive power of ancillary testing. By reducing false-positive results, costly testing can be avoided. “Bedside” treatment extends to all physical interactions with our patients, which are integral for an appropriate diagnosis and care plan. Correctly