Review of systems

The review of systems is a weird part of the interview that I haven’t quite gotten my head around yet.  Basically, it’s a series of head-to-toe questions that act as a grab-bag for “anything else going on.”  In theory this sounds great, and sometimes you do pick up something relevant in the ROS.  For instance, my clinic patient who endorsed bleeding gums and easy bruising, who coughed up large clots of blood after his laryngoscopy.

Mostly, though, the ROS is a minefield.  If you ask someone if some part of their body hurts, chances are they will spend about 30 seconds considering and then often as not say yes.  Which means you have to spend the next several minutes exploring their head pain, neck pain, chest pain, abdominal pain…. Sometimes we get so caught up in teh review of systems that I forget what the chief complaint is.

In the inpatient setting, there is a little more time to address and think about the ROS.  In clinic, though, there are so many people to get through that it hardly seems worth it to actually go through the checkboxes.  But then skipping hte review of systems, or checking off “Normal” for everything, is poor care, even I know that.

My attending today, on this dilemma: “There is reality, and then there is what actually happens.”


2 thoughts on “Review of systems

  1. Interesting to read this here after just reading a chapter in How Doctors Think about ROS. Here’s what it had to say:

    Given a good stock of general clinical knowledge, a physician’s survey of apparently unrelated organ systems proves invaluable in the absence of the specific, detailed information and specialed experience that constitute expertise. The habit of conducting a review of systems with every patient, inculcated early, remains the default mode for clinicians who are not in the grip of an overriding, fully satisfactory hunch.

    The article that was used to back all of this up is found here:

    Just thought it was interesting.

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