In the frenetic world of daily clinical practice, doctors struggle to keep all the balls in the air in the limited time allotted. I find that I focus mostly on history, because the words of the patient are the most sensitive diagnostic tool I’ve yet come across. The physical exam primarily serves as an adjunct, to confirm or rule out a diagnosis that was suggested in the history. Once in a while, though, something completely unprompted from the history will arise from the physical — an unexpectedly enlarged liver, a nodular thyroid, an unnoticed skin lesion. Though this doesn’t happen often, it is a good reminder of the utility of the physical exam. But the ease and temptation of CTs and M.R.I.s, the constant fear of lawsuits, the impossibility of time, and — let’s face it — the atrophy of our skills, have combined to push the physical exam onto the back burner. A decade ago people were predicting the permanent demise of the physical exam. Dr. Abraham Verghese and other physicians have been leading the recent call to revitalize the art of the physical exam, making the valid point that a good physical exam can obviate the need for many expensive tests. They also emphasize the importance of the exam as a connecting ritual between doctor and patient.
Posted on: Thu, 10 Jul 2014 12:09:49 +0000