Take a good history, do a good exam.

• Rather than doing a careful history and physical, many physicians resort to order expensive tests based on a complaint rather than a full history.
• Physicians almost unanimously believe that other physicians do this and some will admit that they are guilty also.
• Our predecessors were able to gather essential pieces of clinical data from a physical exam.
• Today, in the world of overburdened emergency departments, full hospitals, and electronic ordering and note-writing systems, we are forced to spend less and less time with our patients.

• In an attempt to compensate for this problem, we make up in quantity what we cannot provide in quality – and we make up with money what we cannot provide in time.
• Although the perception is that patients benefit, by getting a myriad of lab tests and imaging studies, they do not. These tests mean very little unless they are correlated clinically.
• Clinicians have begun to practice test-centered medicine rather than patient-centered medicine.
• This causes huge delays and expenses in patient care and also places patient at risk for
  1. Being treated unnecessarily for incidental findings
  2. Being exposed to unnecessary radiation.
• Furthermore, it alienates patients even further from their physicians – and this, perhaps, is the greatest cause of increased lawsuits and patient dissatisfaction, which starts the cycle of practicing defensive medicine all over again.
• Careful history helps us make a diagnosis without needing shotgun testing.
• Less often, but just as important, a targeted physical examination helps us make a diagnosis.

Read More on http://www.kevinmd.com/blog/2010/09/doctors-order-tests-history-physical.html