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The Physical Exam as Refuge: NY Times Article By Julie Rosenberg | 11 Jul, 2014

This article talks about trends in the use of the physical exams among doctors. The time crunch, number of issues to discuss even without an exam, the ability of technology to better detect some conditions (or protect physicians from lawsuits) all led to diminishing use of the physical exam. But, doctors are returning to the use of the physical exam now for a different reason--to connect with patients. The physical exam, touch, helps patients open up about issues they might not otherwise mention and build trust. This is an interesting reminder of how easy it is to overlook the value of certain practices or what they can do for quality of care if we measure the wrong things. The utility of physical exams rests not in what they directly reveal but in how they influence patient's psychologically.

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Replies

 

Lindsay Jubelt Moderator Emeritus Replied at 10:59 PM, 24 Jul 2014

Julie,

What a great topic. I believe we are starting to see a resurgence of the physical exam in medical schools. I wonder if this is a true resurgence or it's last hurrah.

As an intern, I remember smartly informing a patient in clinic who asked about a breast exam, that there was no conclusive evidence supporting it. She could be breast exam free! Months later, when reading through patient comments, I came across one comment that read, "My doctor told me I didn't need a breast exam. My old doctor always did a breast exam. I'm looking for a new doctor." The message to me was simple -- the physical exam isn't always about the evidence. Or clinical reasoning, for that matter.

What are others' experiences? As providers? Or patients?

Abraham Verghese has been a great proponent of the physical exam.

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Elizabeth Glaser Replied at 10:53 AM, 25 Jul 2014

As a clinician, I have learned so much from observing physicians do a physical exam. And you can see the difference between those who are skilled in it and those who are not. The good ones listen to the patient, they touch, check BP, they palpate , percuss, etc.They explain what they are doing and why, check labs either before the exam or after, and don't check phones or devices in the middle of things. They are present for the person in from of them.

As a patient, a mother, and a caretaker for an elderly parent, I get a huge sense of relief when the doctor does this kind of methodical exam. It may be problem oriented , it may be brief, but it gets to the heart of things. And even if the diagnosis ends up not to be correct, I feel that the doctor's process was correct. So my unsupported bias is to believe that doctors who do a good physical exam are less likely to be sued. Does anyone have data on this?

Elizabeth

Mighty Casey Replied at 11:17 AM, 25 Jul 2014

As a hosp-med journalist, I see and hear the love of the physical exam from the clinicians I interview all the time.

At the SHM annual meeting in '13, I had the pleasure of attending an intensive pre-course on bedside procedures guided by ultrasound, and a workshop titled "Channeling Osler" that focused on the importance of hands-on exam skills. The most memorable, though, was a third session called "History of the Physical Exam," presented by Dr. Alberto Puig. He had an SRO crowd riveted, by turns groaning, gasping, and almost ROFLing.

In re Dr. Glaser's question above, I followed some virtual breadcrumbs to an article on the Cleveland Clinic Journal site to the attached link, which has beaucoup reference links in addition to a pretty tight call for better hands-on skills.

And for grins'n'giggles, the short video feature I produced on the Channeling Osler session at HM13.

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natascha mezquia Replied at 12:03 AM, 24 Jul 2016

the problem of deterioration of the clinical method is universal and independent of technology development although it is undeniable that this trend has influenced significantly in underdeveloped countries the situation becomes dangerous by the lack of access to it, in my country there is a movement of rescue method for clinical use has been one of the characteristics of Cuban medicine

natascha mezquia Replied at 12:26 AM, 24 Jul 2016

I just read my article "The stethoscope as a metaphor" I think it's great, can understand many things that are happening to us today in the medical community, primarily related to the lack of empathy with patients and families, I believe we can not be Healers men without knowing the inner workings of the human species, in medical school do not teach it, unlike ended thinking that are above them and that's too bad, we can never make good diagnoses using the clinical method if you do not optimize the doctor-pacient relationship

natascha mezquia Replied at 12:27 AM, 24 Jul 2016

I apologize in advance for my poor command of English, which could lead to communication problems

This Community is Archived.

While this community is no longer active, we invite you to review and recommend past posts and resources. Membership for this community is closed, but we hope you'll join us in one of the many other communities on GHDonline.

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