Medical Physical Exams – A lost art

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I heard somewhere during my naturopathic medical training that a good physical exam, good detailed history taking and the use of the stethoscope can give a physician up to 80% of what they need to determine a diagnosis.

Being a doctor is an art and a science.  The art part seems to be lost.

Physicians are so dependent on costly medical testing that you wonder why doctors are needed at all.

I have probably saved about a dozen lives in my career from doing a complete physical exam on patients. In some cases I have detected heart sound abnormalities where I referred to a cardiologist, tumor growths on abdominal palpation where the patient was correctly referred to a gastroenterologist, and aortic aneurysm’ which earned them an immediate trip to the emergency room from my office.

In today’s New York Times there is a fantastic article title: Physician Revives a Dying Art: The Physical where Dr. Abraham Verghese, a Stanford University physican, talks about the lost art of a physical exam.

In the article he contends that , “Some doctors would gladly let the exam go, claiming that much of it has been rendered obsolete by technology and that there are better ways to spend their time with patients. Some admit they do the exam almost as a token gesture, only because patients expect it.”

Regenerating the art of medicine: listening, touching and looking, can build a sense of trust between patient and physician. It can reinforce the healing power of touching which can soothe, comfort and convey caring all of which can positively contribute in the healing process of the patient.

Have you ever observed a sick child? What do they want most? Children’s Tylenol? No, they want to be carried and hugged. Our need for human contact is necessary. Babies who are not touched fail to grow normally.  And that’s shameful because our society is becoming a “hands-off” environment.

When you listen closely to patients as they describe their ailment they often tell you what they have and how to treat it. If doctors are to meet the needs of their patients they must first listen with an empathic ear and practice responsive communication. Listening is the doctors’ window to what is going on inside.

Indeed, physician’s need to reclaim the art of being a doctor. This will not only help us from a diagnostic perspective, but also therapeutic for the patient.

In optimal health,

Dr. Geo

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by Dr. Geo

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