I was always taught that the physical examination was the most important part of the patient visit. Dr. Rob at Musings of a Distractible Mind just pointed out the diagnostic value of the "laying on of hands". But my teachers, back in the day, used to emphasize how reassuring it was to the patient.
I am always pleasantly surprised by my patients when they say I had done a more complete exam than they'd had for years.
Really? But with high blood pressure, diabetes and heart disease, you must be in the office every other month?
Why do I have to justify NOT doing an echocardiogram when it has all the features (new, soft, disappears on lying down, no radiation) of a benign murmur? Why did my service chief give me a congratulatory call a few years ago for picking up an abdominal aneurysm when a resident overlooked it (it was obvious)? Why do I find lymph nodes in the posterior chain that nobody else seems to look for? Some of my former teachers believed I was barely adequate at physical diagnosis. I have trouble taking compliments now.
Physical examination provides diagnostic accuracy and reduces the cost of unnecessary testing. More importantly it increases the patient's confidence and enhances the relationship.
But why listen when you can order a scan?
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I too have been told that I take a very long time listening to the heart on exam. It confuses me because I am just doing what I think I must do, rather than anything above and beyond. I was complimented for picking up a retinoblastoma in an infant, but surely any pediatrician worth his salt would have picked it up. It was obvious. There is value in a careful exam, to be sure. I think it shows I am doing more than just "doing a job," I am taking the time to examine the evidence and make the best decision possible. Does this save money? I think it may. But more than that, it fulfills the contract I have with the patient to do my best for them.
Where do you get this nonsense? Whether tests are better than physical exams is an empirical question. I'm so glad, doctor, that your selective memory, combined with confirmation bias, has established the amazing things the physical exam does. Give me nice, randomized studies showing one method is better or the other.
As for the touching, nonsense--you're wrong. I only pay people to touch me when in certain neighborhoods in Bangkok. I avoid going to the doctor's because it's gross.
The physical exam is a form of rape in which the physician establishes his/her authority. Why else would doctors be so attached to it, without any scientific evidence that it is preferable to competing diagnotic tools.
To Anonymous,
Thanks, I love comments!
I would suggest that patients are more attached to testing than physicians, which is why we order more than we otherwise might. I am urging physicians to be more meticulous and to fall back on their training.
Randomized studies are usually done for treatment, not diagnostics. The trials are usually done to justify the cost of a new technology, not to obviate something as simple as an examination. In fact, much technology is used for purposes they were not intended and tests relied on far beyond what the epidemiology can support.
On a more serious note, I can see you have had some terrible experiences with the health care system and physicians in particular. I am truly sorry that you had to endure something so terrible that you would resort to the use of a word like rape.
hey zagreus ammon (or does an "o almighty" go before that--)
1. I'm an epidemiologist; using randomized studies to examine the effectivness of diagnotics is quite common. Indeed, if medicine were more rational, evidence-based and market based, there'd be more it.
2. "fall back to their training" uhh . . . why? Should they also apply leeches? All medical practice must be supported by evidence; otherwise, it's called voodoo, not science.
3. I've never had bad experiences with doctors. I don't like it. There's a difference. I appreciate your false pity--but I suppose that's just part of your job.
I love idiot bloggers!
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