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William Aird: What Does a Complete History and Physical Really Mean?
William Aird/LinkedIn
Sep 20, 2026, 04:54

William Aird: What Does a Complete History and Physical Really Mean?

William Aird, Professor of Medicine at Harvard Medical School, shared a post on LinkedIn։

“WHAT IS A ‘COMPLETE‘ HISTORY AND PHYSICAL?

I caught myself in clinic recently asking yet another patient whether they smoked and how much alcohol they drank.

Neither answer was particularly relevant to the hematologic problem I was evaluating.

But I realized I would have felt strangely uncomfortable not asking.

It made me think about how much of the traditional history and physical we perform because we were taught that this is what a complete H and P contains.

Social history: smoking and alcohol.

Family history: cancer, heart disease, diabetes, and an expanding cast of relatives.

Physical examination: heart, lungs, abdomen, extremities.

Sometimes these are enormously important.

Smoking matters when evaluating erythrocytosis.

Alcohol matters in macrocytosis or thrombocytopenia.

A family history can completely redirect the evaluation of an unexplained cytopenia.

And of course there are plenty of hematologic problems where lymph nodes, spleen, skin, or cardiopulmonary examination matter.

But should I auscultate the lungs of every asymptomatic patient who comes to see me for iron deficiency?

Do I need to know that their cousin had prostate cancer?

Every question and every examination maneuver has a cost: time, attention, sometimes intrusion, and occasionally false-positive findings.

Maybe a good history and physical shouldn’t be defined by how much we include.

Maybe it should be defined by how thoughtfully we choose what to include.”

Other posts featuring William Aird on Hemostasis Today.

 

clinical assessment clinical decision making clinical reasoning diagnostic approach evidence-based medicine healthcare Hematology Hemostasis News Hemostasis Today history and physical examination medical education medical history patient-centered care physical examination physician practice William Aird
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