The Rational Clinical Examination: Evidence-Based Clinical Diagnosis

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April 30, 2008


Electronic book text, 732 pages

Other Formats


0071590315 / 9780071590310

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Main description

The ultimate guide to the evidence-based clinical encounter

"This book is an excellent source of supported evidence that provides useful and clinically relevant information for the busy practitioner, student, resident, or educator who wants to hone skills of physical diagnosis. It provides a tool to improve patient care by using the history and physical examination items that have the most reliability and efficiency."--Annals of Internal Medicine

"The evidence-based examination techniques put forth by Rational Clinical Examination is the sort that can be brought to bear on a daily basis - to save time, increase confidence in medical decisions, and help decrease unnecessary testing for conditions that do not require absolute diagnostic certainty. In the end, the whole of this book is greater than its parts and can serve as a worthy companion to a traditional manual of physical examination."--Baylor University Medical Center (BUMC)Proceedings

"Physical diagnosis has been taught to every medical student but this evidence-based approach now shows us why, presenting one of medicine's most basic tenets in a new and challenging light. The format is extraordinary, taking previously published material and updating the pertinent evidence since the initial publication, affirming or questioning or refining the conclusions drawn from the data.
"This is a book for everyone who has studied medicine and found themselves doubting what they have been taught over the years, not that they have been deluded, but that medical traditions have been unquestionably believed because there was no evidence to believe otherwise. The authors have uncovered the truth.
"This extraordinary, one-of-a-kind book is a valuable addition to every medical library."--Doody's Review Service

Completely updated with new literature analyses, here is a uniquely practical, clinically relevant approach to the use of evidence in the content of physical examination. Going far beyond the scope of traditional physical examination texts, this invaluable resource compiles and presents the evidence-based meanings of signs, symptoms, and results from physical examination maneuvers and other diagnostic studies. Page after page, you'll find a focus on actual clinical questions and presentations, making it an incomparably practical resource that you'll turn to again and again.

Importantly, the high-yield content of The Rational Clinical Examination is significantly expanded and updated from the original JAMA articles, much of it published here for the first time. It all adds up to a definitive, ready-to-use clinical exam sourcebook that no student or clinician should be without.


  • Packed with updated, new, and previously unpublished information from the original JAMA articles
  • Standardized template for every issue covered, including: Case Presentation; Why the Issue Is Clinically Important; Research and Statistical Methods Used to Find the Evidence Presented; The Sensitivity and Specificity of Each Key Result; Resolution of the Case Presentation; and the Clinical Bottom Line
  • Completely updated with all-new literature searches and appraisals supplementing each chapter
  • Full-color format with dynamic clinical illustrations and images
  • Real-world focus on a specific clinical question in each chapter, reflecting the way clinicians approach the practice of evidence-based medicine
  • More than 50 complete chapters on common and challenging clinical questions and patient presentations
  • Also available:, a new interactive database for the best practice of evidence based medicine

Table of contents

1.A Primer on the Precision and Accuracy of the Clinical Examination
UPDATE: Primer on Precision and Accuracy
2.Does This Patient Have Abdominal Aortic Aneurysm?
UPDATE: Abdominal Aortic Aneurysm
3.Does This Patient Have Abdominal Bruits Useful in the Evaluation of Hypertension?
UPDATE: Abdominal Bruits
4.Does This Patient Have an Alcohol Problem?
UPDATE: Problem Alcohol Drinking
5.Does This Adult Patient Have Appendicitis?
UPDATE: Appendicitis, Adult
6.Does This Patient Have Ascites?
UPDATE: Ascites
7.What Can the Medical History and Physical Examination Tell Us About LowBack Pain?
UPDATE: Low Back Pain
8.Does This Patient Have Breast Cancer?
UPDATE: Breast Cancer
9.Does This Patient Have a Clinically Important Carotid Bruit?
UPDATE: Carotid Bruit
10.Does This Patient Have Carpal Tunnel Syndrome?
UPDATE: Carpal Tunnel
11.Does This Patient Have Abnormal Central Venous Pressure?
UPDATE: Central Venous Pressure
12.Does This Patient Have Acute Cholecystitis?
UPDATE: Cholecystitis
13.Does the Clinical Examination Predict Airflow Limitation?
UPDATE: Chronic Obstructive Airways Disease
14.Does This Patient Have Clubbing?
UPDATE: Clubbing
15.Is This Patient Taking the Treatment as Prescribed?
UPDATE: Compliance and Medication Adherence
16(A).Can the Clinical Examination Diagnose Left-Sided Heart Failure in Adults?
16(B). Does This Dyspneic Patient in the Emergency Department Have Congestive Heart Failure?
UPDATE: Congestive Heart Failure
17.Is This Patient Dead, Vegetative, or Severely Neurologically Impaired? Assessing Outcome for Comatose Survivors of Cardiac Arrest
18(A).Does This Patient Have Deep Vein Thrombosis? (1998)
18(B). Does This Patient Have Deep Vein Thrombosis? (2006)
UPDATE: Deep Vein Thrombosis
19.Is This Patient Clinically Depressed?
UPDATE: Depression
20.Does This Patient Have a Family History of Cancer?
UPDATE: Family History of Cancer
21.Does This Patient Have a Goiter?
UPDATE: Goiter
22.Does This Patient Have Hepatomegaly?
UPDATE: Hepatomegaly

Author comments

David Simel, MD, MHS,
Chief, Medicine Service
Durham Veterans Affairs Medical Center
Professor of Medicine
Duke University School of Medicine
Durham, NC

Drummond Rennie, MD
Chicago, IL
Philip R. Lee Institute for Health Policy Studies
University of California, San Francisco
San Francisco, CA

Copyright 2014 McGraw-Hill Global Education Holdings, LLC


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