Psychiatric assessment and the art and science of clinical medicine

The decline of phenomenology was associated with the corresponding rise of operational criteria for psychiatric diagnosis. Detailed and nuanced evaluations were replaced by symptom checklists, the diversity of clinical phenomena reduced to a few “typical symptom” and contexts ignored in favor of symptom criteria. This article highlights some issues related to the art and the science of clinical examination. It includes conceptual models, matching patients with typical typologies, cross-sectional and longitudinal perspectives, symptom checklists and contexts, population characteristics, prevalence and predictive values, demarcation of abnormalities, and the Bayesian approach to diagnosis. The challenge is to rekindle the interest in phenomenology, appreciate the complexity of the task of psychiatric assessment and to teach the principles of clinical examination.