Sorry to stay clinical, when your issues are larger. But I guess I'm now in my dotage. It was what I was about.
My son-in-law, a bull-strong, ever-healthy man of 50, had sudden pain in his right lower abdomen, accompanied by fever, leukocytosis (20,000/mm3), but no vomiting. Over the next 5 (count 'em, 1,2,3,4,5) days he was tested, probed, scanned, cultured, sent home, and brought back to see his doctor for another blood count. Nobody (but this archaic ol' physician did a physical examination. He had what we used to call a positive chandelier sign when I pushed on McBurney's point fore and aft (per rectal). (He hit the ceiling.)
Back to his P.M.D. Referred post-haste to a g.i. guy who took out his appendix with a laparoscope. Golly! He stayed sick! Antibiotics in hospital x 8-9 days didn't help! Two weeks after his initial procedure ("abscesses take time to be seen"), a pelvic ultrasound showed a softball sized pelvic mass with central loculations.
The mass was needled, drained, lavaged, and the area again examined laparoscopically. Fever, weakness, malaise persisted x 3+ weeks, slowly improving with home-delivered antibiotics given per PICC line.
This man is a stockbroker. His slow recovery cost him and his firm lots of dough, to say nothing of potential clients lost or discouraged.
Add to that the costs of readmission, hospitalization, reoperation, imaging studies, O.R. and I.C.U time, blah, blah, blah. This all occurred at one of the city's most prominent medical centers.
Medicine has First, Second, Third and Fourth principles.
1. Talk to the Patient. And be humble enough to listen.
2. A physical examination is a GOOD thing. Takes 5 minutes! It can be helpful.
3. Principles of care haven't changed much since Hippocrates' time, or perhaps since the days of early man:
Clean out the crud! To clean it one has to see it. To see it, one needs exposure!
Is there any difference between 3 one cm incisions and one 3 cm incision?
4. Abrogation of any of the first