ABSTRACT
The ideology behind cynical acumen is, if not pure, certainly simple. If the people are to help the patient in front of the reader to the best of their ability, then it seems self-evident that they should start off by making the correct diagnosis. Put like that, the whole thing doesn’t sound particularly cynical, indeed might appear entirely laudable. The test is most effective when the patient finds all or nearly all the processes excruciatingly painful when gently pressed – an unlikely finding that is surprisingly common. The GP has already done all the right things, and there’s no suggestion the woman has rheumatoid arthritis. Not revealing the purpose of examination is, of course, only useful in certain circumstances. There is little point in hiding the fact the people are listening for mitral stenosis in the hope that the patient will give themselves away by feigning the murmur of aortic incompetence.
