Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3074_Библиотеки_им_академика_М_И_Перельмана.pdf
123
Bedside Approach to
the Physical Examination
Steven H. Yale
Halil Tekiner
Eileen S. Yale
Ryan C. Yale
Gastrointestinal
Eponymic Signs
Gastrointestinal Eponymic Signs
StevenH.Yale • HalilTekiner
EileenS.Yale • RyanC.Yale
Gastrointestinal Eponymic
Signs
Bedside Approach tothePhysical
Examination
ISBN 978-3-031-33672-0 ISBN 978-3-031-33673-7 (eBook)
https://doi.org/10.1007/978-3-031-33673-7
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Paper in this product is recyclable.
StevenH.Yale
College of Medicine
University of Central Florida
Orlando, FL, USA
EileenS.Yale
College of Medicine
University of Florida
Gainesville, FL, USA
HalilTekiner
School of Medicine
Erciyes University
Kayseri, Türkiye
RyanC.Yale
The Home Mag
Ponte Vedra, FL, USA
To Joseph J.Mazza, MD, MACP, former
emeritus researcher at Marsheld Clinic
Research Institute, Marsheld, Wisconsin. He
is a true master clinician who passed on his
unwavering enthusiasm and true joy in
learning. He inspired me to listen and think
critically while always keeping the patient’s
best interest in mind.
To John R.Schmeltzer, Ph.D., former
Director and Health Economist-Health
Services Research at the Marsheld Clinic
Research Institute, Marsheld, Wisconsin,
who passed on his unique gifts of passive
listening, silent leadership skills, and
providing clarity even to the most
complex issues.
Steven H.Yale, MD
To the beautiful memory of my grandparents,
Şengül and Halil Has, who reunited before
this book was completed. They will forever
continue inspiring my academic paths.
Halil Tekiner, PhD
To the memory of my parents, Thomas and
Eileen Scott, for their unconditional and
unwavering love and support they provided
to my family and I throughout our lives.
Eileen S.Yale, MD
vii
Foreword
We were initially unsure whether to include a foreword to accompany this book. We
asked about its purpose, goal, and what we hope to gain. The message had to say
something that would titillate or inspire the reader. Most importantly, who should
write it? There are many inspiring, prominent medical historians in the eld, but the
bygones of those who left indelible marks on the physical examination have since
passed. These include such persons as Elmer L.DeGowin, M.D. (1901–1980), and
his son Richard L.DeGowin, M.D. (1934–2021), coauthoring Bedside Diagnostic
Examination in 1969, as well as Barbara Bates, M.D. (1928–2002), authoring A
Guide to Physical Examination and History Taking in 1974. Regarding physical
signs, Hamilton Bailey, M.D. (1894–1961), authoring Demonstrations of Physical
Signs in Clinical Surgery in 1942, remains the time-honored name of clinical
examination and diagnosis benchmark.
Learning the physical examination is a rite of passage in medical school. The
physical examination is taught as a series of steps by which students are expected to
master their sense of observation, auscultation, palpation, and percussion and are
assessed based on how well they apply and perfect these skills. Unfortunately, these
skills are not surprisingly lost over time since they are neither routinely used nor
reinforced. It is always perplexing to hear when the learner reports that the physical
examination is normal in the presence of a mountain of pathological abnormalities.
The realization that signs of the physical examination can provide so much more
information serving as an additional potential mechanism for diagnosing disease
sparked our interest and passion for understanding them further. This “hands-on”
approach through these signs now has meaning and signicance and may tell you
something about what is going on with the patient.
This book lls the gaps in the literature and misattribution about the correct use
of these signs. We argue that they should only be dismissed from medical discourse
once they have been appropriately vetted or studied. We recognize that the signs
could only be studied in their correct form once a standard description was available
as told in the authors’ own words. For reasons that are not entirely clear, many of
these signs deviate from the authors’ initial descriptions, thus making any inference
about their signicance impossible.
viii
The other challenge we faced was how to guide instructors to teach these signs
and simultaneously stimulate the learner’s interest. We recognize that one of the
most enjoyable ways of learning is through storytelling. Morning report, an
inquisitive exercise where cases are presented, is a time-honored traditional exercise
of storytelling in medicine. The audience, generally consisting of medical students,
residents, and faculty, applies the Socratic method to foster critical thinking skills.
The stories we told in our books were about these physicians whose accomplishments,
in many cases, left an indelible mark on the next generation of their students and
humankind. As you read the stories, you realize that they are more than just their
name on a sign ascribed to them postmortem. Many of these physicians were
prominent leaders in their hospitals and societies and pioneers in medicine and
surgery, designing tools and devising techniques to move the eld further.
Unfortunately, we learn that a few of these physicians committed atrocities against
humanity. Furthermore, because of the war and antisemitism, some physicians were
forced to leave their posts and ee to another country.
The antagonist will argue that the world has evolved, and this information is anti-
quated and no longer required in patient care. Patients are now frequently whisked
away for laboratory and imaging tests before the physician has taken an appropriate
history or placed their hands on the patient. Suppose no abnormality or an unex-
pected nding is found. In that case, the physician nds themselves having to start
over again to identify what they missed—a costly error not only in terms of expense
but inconvenience and delayed diagnosis for the patient. It would be difcult to argue
that this is a cost-effective or appropriate evidence-based approach to patient care.
So why should a medical student, resident, or faculty read this book and our prior
one, Cardiovascular Eponymic Signs: Diagnostic Skills Applied During the Physical
Examination? We hope that these books become an essential addition to the libraries
of the history of medicine and physical examination and that the information they
contain be further studied so that we can learn about the signicance of these signs.
In the interim, we believe that the sign augments the physical examination and pro-
vides a more rational way of approaching testing and diagnosis.
Steven H. Yale, MD
College of Medicine
University of Central Florida
Orlando, FL, USA
Halil Tekiner, PhD
School of Medicine
Erciyes University
Kayseri, Türkiye
Eileen S. Yale, MD
College of Medicine
University of Florida
Gainesville, FL, USA
Foreword
ix
Preface
Over the past veyears, the authors have written collaboratively on a variety of
topics related to medical eponyms. We had just completed our rst book titled
Cardiovascular Eponymic Signs: Diagnostic Skills Applied During the Physical
Examination and were now interested in telling the stories about those physicians
who described signs involving diseases of the gastrointestinal tract. Our goal was to
pass on this knowledge so that others could appreciate how their lives impacted
medicine and how others beneted from their presence. Additionally, we sought to
provide the learner with an appreciation for how these bedside physical examination
techniques afford a richer perspective on the pathophysiology and diagnosis of
disease.
Medicine continues to progress and will undoubtedly become even more
technologically advanced in the future. However, despite these advancements, one
aspect remains constant: the best physicians are still those who have skillfully
perfected the ars medicinae which requires excellence in patient history and a
physical examination as a prerequisite for sound clinical reasoning and diagnosis.
Technological advancements have made medical care delivery more sophisticated
and costly. Moreover, it seems it has also resulted in a less personalized
doctor-patient relationship as technology substitutes for, rather than complements,
doctor-patient interactions. Is it any wonder then that physical examination skills
decline in disuse? Or that there appear to be adverse consequences caused by the
incongruency between what should be done for patients and what is actually being
done to them.
We recognize that many signs are not taught, given only cursory attention during
medical education, and have not been well studied. Hence, their reliability, validity,
and utility in diagnosis in many cases are limited or currently unknown. Furthermore,
the description of how to perform the sign may depart from the way it was originally
intended, further contributing to misattribution, misinformation, and
misunderstanding. In this regard, medical eponyms are akin to folklore, where
information is modied over time such that the meaning of the sign may now differ
from its original text.
x
This book intends to clarify inconsistencies and imperfections within the
medical literature and provide an accurate account of the description of the sign by
quoting the original text. Thus, we wrote this book to demonstrate to students and
physicians that the skills of observation, palpation, percussion, and auscultation
applied at the bedside through the conduit of what is named “signs” is the method
that makes inferences in diagnosis. Moreover, the sign as a critical aspect of the
physical examination provides an additional benet of connecting the patient with
the physician, which is fundamental to the goal of patient-centeredness. We intend
this book to ll some of those gaps and titillate discussion and interest in further
studying these signs.
Orlando, FL, USA StevenH.Yale
Kayseri, Türkiye HalilTekiner
Gainesville, FL, USA EileenS.Yale
Ponte Vedra, FL, USA RyanC.Yale
Preface
xi
Acknowledgments
Writing a book is a tremendous undertaking for those so adventurous to assume
such a task. We were inspired by our students and other learners who maintain a zest
for acquiring new knowledge while understanding the relevance of the bedside
physical examination to the art of medicine.
We thank the University of Central Florida librarian staff for obtaining the
original manuscripts. Without their work, this book would never have been possible.
We thank Ryan Yale BFA, graphic designer, for his clear and precise illustrations,
which brought to life these bedside techniques. We acknowledge Allison Yale, who
reviewed the manuscript and provided her grammatical expertise, and Rekhta
Muthusamy, Project Coordinator at Springer Nature, who supported us throughout
the publishing process.
Eileen & Steven Yale, MDs
This book could not have been possible without the assistance of many scholarly
friends, colleagues, and staff of several libraries, scientic institutes, and national
academies of medicine and surgery in more than a dozen countries. I would
especially like to express my gratitude to Dr. Bruno Bonnemain, President of the
French Society for the History of Pharmacy; Arne Püger, Deputy Head of Business
Development Department at the Library of Marburg Philipps University in Germany;
and Laura N. Braga, librarian at the National Library of Argentina, for their
extraordinary cooperation and precious guidance in assembling some
difcult-to-obtain sources in French, German, and Spanish.
I am grateful for the intellectually stimulating and collaborative working
environment I have been afforded for the last 10 years at Erciyes University in
Kayseri, Turkey. I thank the Rector, Prof. Dr. Fatih Altun, and my colleagues and
friends at the Schools of Medicine and Pharmacy for their continuous encouragement
and unwavering support. I feel deeply indebted to my dear family members—Emel,
İrfan, Sibel, and Kasım—and my beautiful Three-B(ee) nieces—Beren, Beste, and
Buse—for not only being helpful and patient but also indulgent for the limited time
I was able to spend with them during the preparations of this book.
Halil Tekiner, PhD