This happens too often in my opinion. A patient comes to the emergency department after a syncopal episode. The next day on rounds, the intern reports that he/she ordered orthostatic blood pressure but it was not done.
Now, some medical pundits have suggested that the physical exam is no longer relevant. No serious internist really believes that.
The first step in evaluating syncope is checking for orthostatic hypotension. If the patient does have orthostatic hypotension, then the pulse response can certainly help.
In such patients, measuring the blood pressure and pulse is usually the most important part of the physical exam. Then why do the interns and residents write an order for this measurement?
I do not understand how any physician can evaluate syncope without checking for orthostasis. This integral part of the exam should not be assigned.
(old man standing on his soap box)
db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.