Over half of providers forgo physical exams on patients prior to ordering imaging
Many providers who refer patients for ultrasound do so without first completing a physical examination.
In fact, new data suggest that more than half of these referrers forgo physical exams prior to ordering imaging. Experts recently sought to determine whether this habit impacts clinical reasoning and diagnostic yield; they shared their findings in the European Journal of Radiology.
“History taking and physical examination are considered the cornerstones of medical diagnosis. They raise the probability of a certain diagnosis or differential diagnosis, which increases the yield of subsequent diagnostic tests, such as imaging,” Thomas C. Kwee, MD, with the department of radiology at University Medical Center Groningen in the Netherlands, and colleagues explained. “However, it has been recognized that the quality of physical examination, if performed at all, has been declining over the past decades.”
To get a better understanding of providers’ processes leading up to ordering ultrasound imaging, researchers spoke with patients who underwent a scan at a single tertiary center between December 2024 and April 2025. The team compared the patients’ responses to their demographics, type of referrer who ordered their imaging, the clinical indication for the exam and body region of interest. Outcomes were classified as positive, negative or indeterminate.
Just over 300 cases were included in the review. Of those, 168, 0r 55.6%, were ordered without the referring physician first conducting a physical exam on the patient. Surgical specialists, family physicians and residents were all found to be more likely to take the time to complete a these assessments prior to ordering ultrasound.
In these cases, those who did not undergo physical exams were less likely to have positive imaging findings. However, after adjusting for confounding factors, this finding was not clinically significant.
“This suggests that omitting physical examination before US does not necessarily compromise diagnostic reasoning or reduce the detection of relevant pathology,” the authors noted.
The group suggested that interpreting radiologists should assume the exams they read likely did not include a previous physical examination.
“As reliance on imaging increases, our findings raise important considerations for medical training and workflow distribution, signaling a shift in diagnostic responsibility toward imaging departments when clinical assessment is abbreviated or absent,” the team advised. “Policymakers should respond to this development by reinforcing physical examination training and ensuring radiology services are adequately resourced to meet increased demand.”
Read more about the findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.