Bringing Back the Physical Exam

I shudder when I hear stories of physicians who order a CT scan to evaluate a patient's pain without examining the painful area. So I was happy to read that Dr. Abraham Verghese is on a mission to save the art of the physical exam.

Denise Grady of the NYTimes wrote an interesting article about how Stanford physician Dr. Verghese is teaching students how to perform physical exams that reveal a bounty of useful information about their patients. Verghese, author of Cutting for Stone, worries that the rising use of high-tech diagnostic tests and equipment is leading physicians to skip the physical. 

Fancy tests such as echocardiograms and MRIs provide high-resolution pictures and detailed data about the body that can be invaluable in understanding exactly what is going on with a patient and in making wise treatment decisions. High-tech tests have been an essential factor in my surviving lymphoma.

But diagnostic tests should supplement the physical exam, not replace it. Radiologists can do a better job interpreting the x-rays or scans if given information about the patient obtained through a thorough physical exam by the referring physician. And "[a] proper exam also earns trust, he [Verghese] said, and serves as a ritual that transforms two strangers into doctor and patient."

Comments

[Felicity Lenes]

Read this article and loved it when it came out in the NYT some weeks ago. Always a good thing to remember!

[Wendy S. Harpham, M.D.]

The message to medical students and clinicians is you might be swimming against the tide if you take time to do a thorough exam. You might get castigated for being "too slow." Hold your ground!
With hope, Wendy

[sue c]

Yes, I've noticed the annual physical involves almost nothing physical anymore.