The annual H&P that your PCP doesn't do

Leonard Berlin lberlin at LIVE.COM
Fri Nov 20 17:18:06 UTC 2015

Hi, Michael,
I of course always enjoy reading, and learn much from,  the e-mail correspondences that go back and forth among the members of, and contributors to,  SDIM.  I rarely respond because usually I have nothing to add to the informative and logical commentaries that are sent.  However, your comment about your PCP not having done a H&P on you made me chuckle a bit and thus I can't resist responding as follows (for better or for worse!):
Maybe your PCP knows more than most physicians, and is doing you a favor by NOT doing a complete H & P on you.  In a  study of 183,000 patients followed over a period of 9 years, half of whom had regular H & Ps and half of whom did not, patients who had regular checkups died of CVAs and cancer at the same rate as those who did not undergo H&Ps.  Furthermore, the two groups had the same degree of hospital admissions, disability, and absenteeism from work (Krogsboll, Nordic Cochrane Centre, Copenhagen 10/17/12).
An article discussing the Nordic study, under the headline "Value of Medical Checkups Doubted," appeared in the October 17, 2012 edition of Wall Street Journal.
"Nothing in the complete annual physical examination is based on evidence.  We need to reeducate our patients and ourselves about the dangers of overdiagnosis and to suppress our own anxieties.  There will always remain a small possibility that an exam might detect some  silent, potentially deadly cancer or aneurysm.  These serendipitous life-saving events are much less common than the false-positive findings that lead to invasive and potentially life-threatening tests."     (Rothberg, JAMA 2014;311:2175)
I end with a quotation from an anonymous sage:  "Who knows....who knows....? "
Cheers, Michael, and stay healthy!
Warm regards,

Date: Fri, 20 Nov 2015 15:51:33 +0000
From: mbruno at HMC.PSU.EDU
Subject: Re: [IMPROVEDX] Diagnostic errors related to acute abdominal pain in the emergency department.

Thanks, Julianne, Thanks Ruth.
I’m convinced that a great many diagnostic errors could be avoided by simply improving the quality & comprehensiveness of the H&P.  At our institution, specialist physicians will typically only elicit a focused
 history within their proscribed purview, and then go on to physically examine only their own small bit of “territory.”  My own PCP has also never done a complete H&P on me, and I’ve been seeing him for years!  It seems to me that the only people who actually
 perform a comprehensive “top to bottom” H&P anymore are the medical students (who pay us for the privilege).
All the best,

Michael A. Bruno, M.D., F.A.C.R.

Professor of Radiology & Medicine

Vice Chair for Quality and Patient Safety

Chief, Division of Emergency Radiology
The Milton S. Hershey Medical Center

Penn State College of Medicine

500 University Drive, Mail Code H-066

Hershey, PA  17033

Phone: (717) 531-8703

Fax:      (717) 531-5596

e-mail: mbruno at

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From: Julianne Nemes Walsh [mailto:nemeswalsh at GMAIL.COM]

Sent: Friday, November 20, 2015 10:28 AM


Subject: Re: [IMPROVEDX] Diagnostic errors related to acute abdominal pain in the emergency department.

Thank you Ruth, the data consistent with malpractice claim data findings and certainly an area of focus for preventative educational strategies.   


On Thu, Nov 19, 2015 at 5:34 PM, Ruth Ryan <ruthryan at> wrote:

I can’t get to the whole article, but here is a link to the abstract.
Medford-Davis L, Park E, Shlamovitz G, Suliburk J, Meyer AN, Singh H. Diagnostic errors related to acute abdominal pain in the emergency department.

Emerg Med J. 2015 Nov 3. pii: emermed-2015-204754. doi: 10.1136/emermed-2015-204754. [Epub ahead of print]
Of interest, over 1/3 of high risk abdominal pain pts in the ED in this study had diagnostic errors. The most commonly missed diagnoses were gall bladder disease and UTI, confirming
 once again that it tends to be the most common diagnoses, not the rarest that are misdiagnosed.
2/3 of the cases had breakdowns in the diagnostic process, most often


ordering insufficient tests

problems with follow-up of abnormal test results

Medical writer
Risk management/patient safety
Continuing medical education
(504) 256-8797
ruthryan at


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