Letter From the Lipid Spin Editors: Where Have All the Exams Gone?

In this issue of Lipid Spin, several articles and a tear sheet focus on the importance of the physical exam in the evaluation of the patient with lipid disorders. While the physical examination remains the cornerstone of patient evaluation and ongoing treatment, all too often those of us in a teaching role find this a rapidly disappearing art.

In our lipid clinic, medical housestaff evaluate the patients prior to presenting them to our group for discussion. We then return to see the patient. As a busy referral clinic for patients with lipid disorders, many of these patients exhibit physical findings on examination consistent with either inherited disorders of lipid metabolism or secondary disease states that can cause lipid disorders.

What remains most disturbing to me, is that as an educator, all too often these cases are presented to me without any regard to relevant physical diagnoses. Patients with history and lab results consistent with familial hypercholesterolemia have not had eye exams, skin exams or tendon exams. Patients with possible Type 3 dysbetalipoprotinemia have not had palm or extremity exams, and no investigations have been postulated for physical findings of secondary disease states.

Our trainees are some of the best in the country. They are smart, informed and work hard. I suspect the deficiency is not a lack of interest in the physical exam but rather a dearth of knowledge in Clinical Lipidology. When we return to the patient and highlight obvious exam findings, the excitement and interest is obvious. This moment is what we need to capture as leaders in the field of lipidology.

The future of lipidology is germinating in our trainees. We must foster that interest, feed it, nurture it and grow it. If not, there will be no future leaders. Our trainees, fellows, residents and students are the next generation of lipidologists. Generating interest, with bedside teaching, didactic and interactive learning processes are key to the growth of our field. In the words of Sir William Osler, MD–"Listen to the patient, he (or she) is telling you the diagnosis."