Older doctors are saying that doctors today are spending more time with their computers than at the bedside. Doctor-patient conversations are infrequent and brief. Technological tests are becoming the primary source of information on a patient and the basis for diagnosis.
Today the ability of a doctor to use a physical exam to make an accurate diagnosis is fast disappearing. Today a physician’s exam skills are considered obsolete and are being replaced by technological findings, which are considered to be more objective and accurate.
Insurance, that pays for the tests, accelerated the trend, plus the growing paperwork burden, that doctors have, and many of the generation of mentors who taught physical diagnosis have retired. Today physicians migrate from the patient’s hospital bed to a conference room down the hall where test results –not the actual patient- are examined.
However there are still some physicians who firmly believe that the physical exam should remain and be the starting point for treatment of all patients. They say information gleamed from inspecting blood vessels at the back of the eye, observing a patient’s walk, feeling the liver or checking fingernails can provide valuable clues to underlying diseases or incipient problems. The doctors interviewed said for a surprising number of diseases, diagnosis is based on observation and examination, not a test – Parkinson’s disease, shingles, drug rashes and constructive pericarditis. They say heart murmurs in children – distinguishing “innocent” murmurs from serious ones is an essential, but necessary skill for physicians and can best be done with the physical exam.
These skills, they say, are an essential adjunct to technology and can boost diagnostic accuracy, curb unnecessary and expensive testing and foster a greater connection between patients and doctors. With the physical exam, practitioners can assess enlarged lymph nodes, measure ankle reflexes and perform a knee exam.
With the physical exam the doctor can often find the “obvious” before putting the patient through grueling and expensive tests. Studies have shown that the physical exam can be as accurate or more so, then the technological counterpart.
One physician said the first thing he always does is the fundamental clinical skill – he listens to the heart – because there is information to be learned. These physicians are saying, reviving the bedside medicine and ordering tests, based on the results of a careful physical exam and history will improve the quality of care for the patient and reduce costs.*
- Boodman, Sandra, Emphasis OnTech Has Eroded The Old-Fashioned Physical Exam Diagnosis, Kaiser Health News, Physician News – Spring 2014,