You Can Still Examine The Patient
By
Leonard Zwelling
This short op-ed in The Wall Street Journal on June 26 is by Danny Heitman a columnist for the Baton Rouge Advocate. In it he contrasts the slow, relaxed movement of his kayak on a Louisiana bayou with the jet plane roaring overhead while he is paddling in peace. He goes on to note how the great historian Daniel J. Boorstin described new technology not always displacing older tech. He called it the “displacive fallacy.” Heitman cites television as not having replaced radio, music recordings not replacing live concerts, and cars not displacing bicycles. Even e-books have not displaced the paper kind completely.
This got me thinking as a doctor and a patient.
Not very long ago, I was a patient with acute abdominal pain following surgery to repair a large abdominal hernia. It was pretty clear that I was obstructed and equally clear why. The mesh used to fix me had broken down as this mesh frequently does. (Yes, I did try to get lawyers interested in my case, but they would have none of it.)
Now if I had been my doctor, the first thing I would have done is examine my abdomen and listen for bowel sounds. But is that what happened in 2015? Nah!
Before a doctor even laid hands on me, I was in the CT scanner with contrast and the diagnosis was made.
I still haven’t entirely come to grips with this course of events.
More often than not, when I do see a doctor, the lab tests and imaging trumps the physical exam in determining what the problem is. Now, in all fairness, this was most definitely not the case with the orthopedic surgeon caring for me who made all the diagnosis he needed of my bad back long before he had the confirmatory MRI. In fact, in one of the books my doctor gave me to read about my back it point blank states that diagnoses of back pain with radiation down the leg cannot be made from an MRI. It’s all about history and physical exam.
This goes directly to Heitman’s point about old technology and my main pet peeve about modern medical practice. In my opinion, it is very important for doctors to touch their patients by doing relevant physical exams after taking good histories. There is a bond of trust that develops when humans touch and the healing power of medicine can derive from that bond of trust between physician and patient.
The physical exam and surely the history are not obsolete parts of medical care.
I urge all physicians reading this to lay hands on their patients (with permission, of course) and develop that bond of human trust that is so essential to healing.
CT scanners and MRI machines are great diagnostic tools when used appropriately. So is a careful discussion with a patient and the objective findings of a physical exam. That stethoscope can still be used for more than a prop. Just remember, the most important part is the one that goes between the ear pieces.
2 thoughts on “You Can Still Examine The Patient”
This op ed thrills me!
I cannot tell you how many friends have asked whether my doctor “lays hands on me.” Reportedly their family practitioner or internists does not.
Patients, especially blacks, were taken aback in Charleston, SC, when I would touch them during a complete vascular exam. I agree that physical exam does more than search for diagnostic clues; it establishes a concerned physical relationship with the patients; and of course, it should always be an appropriate relationship.
Dr Eugene Stead at Duke used to remind us: “When all else fails, examine the patient.”
Always!