How accurate are the findings noted during a physical examination?

When I was in training, it was common knowledge that the observations we made when examining patients were important observations that enabled us to diagnose with accuracy the patient’s disease. Over the years since then, a number of physical findings have been shown to be either inaccurate or less than helpful in diagnosing disease states. For example, I was taught a number of maneuvers to determine if abdominal ascites were present. Carefully controlled studies, however, have in recent years demonstrated that the accuracy of physical exam findings predicting the presence of ascites are less accurate than I was taught.