The Importance of Elevated Jugular Venous Pressure
The Importance of Elevated Jugular Venous Pressure
Once again -- and properly so -- Drazner and colleagues emphasize the value of a properly performed physical examination. They, like other authors, suspect that the deterioration of the skill is related to the plethora of high-tech facilities.
I believe this deterioration is caused largely by teaching-attendings who supervise medical students and house officers but fail to teach the trainees how to examine patients. I have seen trainees who have finished their residency unable to examine the neck veins and unaware of pulsations of the internal jugular pulse. They simply ordered various procedures and copied what the report said. So there they were -- unable to examine patients and unable to perform the procedures they ordered. They were simply able to read what others said about their patients.
It is reassuring to recognize that the faculty of medical schools, and those responsible for house staff training, have recognized this flaw in medical education and are beginning to re-emphasize the skills of history taking, physical examination, the interpretation of the chest x-ray film, and the interpretation of electrocardiograms.
Drazner and his colleagues completed an elegant study in which they proved -- once again -- that an elevated jugular venous pressure and an S3 gallop sound predicted a poor prognosis for patients with heart failure. The importance of being able to conduct a physical exam properly is illustrated by the results of Drazner's and colleagues' elegant study. They proved -- once again -- that an elevated jugular venous pressure and an S3 gallop sound predicted a poor prognosis for patients with heart failure.
Once again -- and properly so -- Drazner and colleagues emphasize the value of a properly performed physical examination. They, like other authors, suspect that the deterioration of the skill is related to the plethora of high-tech facilities.
I believe this deterioration is caused largely by teaching-attendings who supervise medical students and house officers but fail to teach the trainees how to examine patients. I have seen trainees who have finished their residency unable to examine the neck veins and unaware of pulsations of the internal jugular pulse. They simply ordered various procedures and copied what the report said. So there they were -- unable to examine patients and unable to perform the procedures they ordered. They were simply able to read what others said about their patients.
It is reassuring to recognize that the faculty of medical schools, and those responsible for house staff training, have recognized this flaw in medical education and are beginning to re-emphasize the skills of history taking, physical examination, the interpretation of the chest x-ray film, and the interpretation of electrocardiograms.
Drazner and his colleagues completed an elegant study in which they proved -- once again -- that an elevated jugular venous pressure and an S3 gallop sound predicted a poor prognosis for patients with heart failure. The importance of being able to conduct a physical exam properly is illustrated by the results of Drazner's and colleagues' elegant study. They proved -- once again -- that an elevated jugular venous pressure and an S3 gallop sound predicted a poor prognosis for patients with heart failure.
