SYMPTOMS AND SIGNS IN PULMONARY MEDICINE - OLD OBSERVATIONS AND NEW INTERPRETATIONS

Andre Gide wrote, ''Everything has been said before, but since nobody listens we have to keep going back and beginning all over again.'' To a certain extent, that statement applies to the importance of accurate and systematic history taking and physical examination in clinical pr actice. Although we are trained in habits of comprehension and accurac y in history taking and examination of patients, periodic reminders ar e required to develop a diagnostic framework based on observation (ins pection), palpation, percussion, and auscultation. This monograph reem phasizes the method to be pursued in the treatment of a patient with p ulmonary symptoms. It consists of three parts: (1) questioning the pat ient about his or her medical history; (2) performing the physical exa mination of the respiratory system; and (3) examining the extrapulmona ry signs and symptoms. Once a strong clinical framework has been const ructed, its further development and refinement depend on the clinician 's experience, power of observation, and systematic reading of the med ical literature. Good physicians must continue to learn throughout the ir careers; this is the most essential element of a physician's develo pment. Be patient, however; as Cowper said, ''Knowledge, to become Wis dom, needs experience.''