The Importance of Thorough Examination in Medical Practice

In the fast-paced world of medicine, both patients and healthcare providers often seek quick solutions to alleviate symptoms and expedite treatment. However, the case of Mr. Keleher, a seventy-five-year-old farmer from Central Illinois, underscores the critical importance of comprehensive examinations and the dangers of taking shortcuts in medical care.

Mr. Keleher, a robust man of Irish descent, had worked every harvest since he was ten years old. His recent visits to the clinic were prompted by a troubling weakness in his left arm, which he hoped could be resolved quickly with a chiropractic adjustment. This request reflects a common desire among patients for immediate relief without extensive diagnostic procedures. As healthcare providers, it is our responsibility to balance patient expectations with the necessity of thorough medical evaluation.

The Temptation of Shortcuts

Many healthcare professionals encounter patients like Mr. Keleher, who resist extensive diagnostic procedures in favor of quick fixes. These patients often push for treatments that have provided relief in the past, without considering that new symptoms may indicate underlying conditions that require different approaches. This case highlights the need for practitioners to resist the temptation to take shortcuts and instead prioritize a comprehensive examination to uncover the root cause of symptoms.

Research has shown that diagnostic errors occur in about 5% of outpatient settings in the United States, and these errors contribute significantly to adverse patient outcomes (Singh et al., 2013). A primary factor in these errors is the failure to conduct thorough examinations, leading to missed or incorrect diagnoses. In Mr. Keleher’s case, a regional examination based solely on his initial complaint could have missed the broader implications of his symptoms.

The Comprehensive Examination

When Mr. Keleher presented with weakness in his left arm, a comprehensive examination was conducted, including orthopedic tests, strength assessments, and X-rays. Although the initial X-rays revealed only common arthritic changes, this was not sufficient to explain his symptoms. A critical step was the decision to order an MRI scan, despite the patient’s reluctance. MRI technology, which uses powerful magnets and radio waves to create detailed images of soft tissues, is essential for detecting issues that X-rays cannot reveal (Westbrook, 2011).

The MRI revealed a slight compression of the nerve root at C5-C6, which initially seemed inconsequential. However, continued symptoms prompted further investigation. A full examination, including testing the strength of Mr. Keleher’s legs, revealed subtle weakness in his left leg as well, suggesting a more complex issue. This led to a second MRI scan of the brain, uncovering a large Glioblastoma Multiforme (GBM) tumor, a highly aggressive form of brain cancer (Louis et al., 2016).

The Lessons Learned

Mr. Keleher’s case provides several critical lessons for medical practitioners. First, it emphasizes the necessity of thorough examinations. Despite the patient’s desire for a quick fix, the comprehensive approach ultimately revealed a life-threatening condition that might have otherwise gone undiagnosed until it was too late. This case highlights the principle that thorough diagnostic protocols are indispensable, even when initial findings seem benign or unrelated to the patient’s primary complaint.

Second, the adaptability of the human brain is remarkable. Despite the large size of the tumor, Mr. Keleher’s symptoms were relatively mild, presenting only as subtle weakness. This phenomenon is known as neuroplasticity, where the brain compensates for damage by reorganizing itself (Kolb & Gibb, 2014). It underscores the complexity of neurological conditions and the need for vigilant monitoring and comprehensive testing.

The Role of Patient-Centered Care

While thorough examinations are crucial, it is equally important to maintain a patient-centered approach. Effective communication with patients about the necessity of diagnostic procedures and their potential outcomes is essential. Educating patients on the importance of these steps can help alleviate their concerns and foster a collaborative relationship.


The story of Mr. Keleher serves as a poignant reminder of the irreplaceable value of comprehensive medical examinations. It illustrates that while shortcuts may seem appealing, they can lead to missed diagnoses and adverse outcomes. As healthcare providers, our commitment to thorough, patient-centered care must remain steadfast. By adhering to rigorous diagnostic protocols and maintaining open communication with patients, we can better navigate the complexities of medical conditions and ultimately improve patient outcomes.


• Kolb, B., & Gibb, R. (2014). Principles of neuroplasticity and behavior. In Brain Plasticity (pp. 9-23). Springer, Dordrecht.

• Louis, D. N., Perry, A., Reifenberger, G., von Deimling, A., Figarella-Branger, D., Cavenee, W. K., … & Ellison, D. W. (2016). The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathologica, 131(6), 803-820.

• Singh, H., Meyer, A. N. D., & Thomas, E. J. (2013). The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Quality & Safety, 23(9), 727-731.
• Westbrook, C. (2011). MRI in practice. John Wiley & Sons.

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