Back to Basics

I often hear people talk about how much more prevalent cancer is today than several years ago. It seems like everyone knows someone or has had cancer themselves. But when we really look at what we are seeing today as compared to what was seen 30 years ago are we really seeing new things? Of course there have been some incredible improvements made in diagnosis and treatment of cancer over the last 30 years. Undoubtedly the technology that we have available today has allowed us to suspect and diagnose cancer much more frequently. Does that mean that there is so much more cancer or does it simply mean we can identify it better today? I’m not sure I’m convinced of either one. And has the ability to use such sophisticated technology completely helped our assessment and diagnostic skills or hindered it at all?

This past week I had to sit in on a physical assessment class that my hospital offers. Since I will need to be one of the instructors of the course, I was required to first sit through the class. Of course I thought there were a thousand other things that I could be doing. After all, I am an advanced practice nurse. I did have to pass an advanced physical assessment class in my graduate program and I certainly was capable of assessing a patient. But I have to say, I was very pleasantly surprised at the quality of this class and the realization that, although we might know what to do, we often don’t do it. Truthfully, how many of you really check the cranial nerves of your patient when you assess them? How often do you listen to every lung field, including percussing the, checking for fremitus and CVN tenderness? And do you listen to all of the heart sounds including carotid arteries? Do you routinely feel for lymph nodes and check peripheral pulses in other places besides the dorsalis pedis? There is so much we know but we often don’t use it.

I don’t think that anyone leaves those things out because they’re lazy, don’t know how to do it or are just too busy. I do believe that with the time constraints we have during an active day, we do just what we need to do to get “a good idea.” After all, if we heard something unusual in the lungs, we could simply get a chest x-ray. If I thought I might hear something odd in the heart we can do an EKG or put someone on telemetry. If the pulses are a little hard to find we can do a Doppler, ultrasound or EMG. And why should I check lymph nodes? Any abnormality would certainly show up in the lab work. CV tenderness? Why not just do a urinalysis?

Now, I certainly would not say don’t do any of those tests. After all, they certainly are the standards for diagnosis and help us to provide the best care for our patients. But do they do a little too much too soon for us? Have we become so dependent on technology that we forget the basics? How often have you heard someone actually diagnosed with pneumonia by putting together the pieces of an assessment? Perhaps what we should do is get back to the basics and not only hone our assessment skills but actually put them into practice. We could possibly use the diagnostic tools and technology we have to confirm diagnosis that we were certain of anyway based on our assessment. I think, we do that to some degree, but how impressive it would be to provide that kind of back to the basics care for our patients.