The Physical Examination: Is It of Any Value?
Well, it's time again to teach our first and second year medical students the details of performing a physical exam on patients. But as we do this, there is something in the back of the teacher's mind. What are we actually accomplishing in teaching techniques of the exam? Does what we teach, in practice, provide the doctor with skills that are associated with statistical sensitivity and specificity to make a correct diagnosis? There is uncertainty in this regard, especially since most of what we teach has never been put through the rigorous statistical testing which other diagnostic procedures have undergone. In addition, modern physicians seem to be doing less "hands on" examination to establish a diagnosis and more emphasis on various testing procedures. Well, that is the issue I would like to set for this thread: is the physical exam of any value?
I found an editorial in a 2005 issue of the Medical Journal of Australia written by three physicians Brendan M Reilly, MD; Christopher A Smith, MD; Brian P Lucas, MD. all from Cook County Hospital in Chicago titled "Physical examination: bewitched, bothered and bewildered" which gives a bit of insight into this topic. You can read the entire editorial by going to the above link. The editorial starts out with the following excerpt:
Young physicians today seem confused about physical examination. In the United States, many of them do not know how to do it and do not see why they should. Asymptomatic patients do not seem to need it; the US Preventive Services Task Force found insufficient evidence to recommend periodic physical examination of the breast, prostate, heart or anything else. Sick patients do not seem to benefit much from it either, most of them tested to death regardless of their physical findings. It is hard to say which is the chicken or the egg here, but physical diagnosis instruction in many US medical schools now is either out of date (emeritus faculty members teaching useless arcana like percussion of Traube’s space), out of touch (junior faculty members making rounds in a conference room, not at the bedside), or both.
Young physicians trained outside the US are bewildered about this, too. Many of them, meticulously trained in physical examination, are appalled upon first encountering the “hands off” culture of US medicine. But they learn quickly, in the process often unlearning much of what they had learned before. The pace and clinical impact of this remarkable phenomenon is unknown because no one has studied it, a bewildering thing in itself.
What do you think about the physical exam and your own experiences. Have you been sick but the doctor hardly did any examination? Do you think there is merit in what the editorial's authors wrote later in their editorial 'laying on of hands' improves communication and trust between doctors and patients, somehow 'connecting' them better, not just physically but otherwise." Anyway, I'll be back teaching the physicial examination to the students in a couple of days.. as usual. ..Maurice.