Over the past week I have engaged in many conversations about medicine. I have contemplated medical education and the development of expertise. And yesterday I read this article – No Longer on the Doctor’s Checklist, but Physical Exam Still Matters.
Many experienced physicians decry the loss of skill in history taking and physical examination skills. I have noticed that many students and residents have significant opportunities to improve history taking. They have deficiencies in knowing how to ask questions and knowing what questions to ask. I worried that I was being too harsh, but many colleagues have independently made the same observation.
We just do not do a good enough job emphasizing history taking to our students. Learning to take a great history takes practice and diligence.
Yesterday I once again review the history taking chapter of Cope’s Early Diagnosis of the Acute Abdomen. I urge students to read this chapter, but too often they spend their time reading the study guides for “the test” rather than working on learning how to improve their clinical skills.
Likewise our students and residents have underdeveloped physical diagnosis skills. Here the students are eager for instruction, thus we can only blame ourselves as attending physicians for not finding every opportunity to help them hone their skills.
Dr. Danielle Ofri in her excellent NY Times article opines:
Perhaps that is the crux. Touch is inherently humanizing, and for a doctor-patient relationship to have meaning beyond that of a business interaction, there needs to be trust — on both ends. As has been proved in newborn nurseries, and intuited by most doctors, nurses and patients, one of the most basic ways to establish trust is to touch.
I cringe whenever our hospital administration refers to the doctors and nurses as “health care providers.” That term always makes me feel like a soft-drink dispenser at Burger King. I’m not a “provider”; I’m a person, a doctor. And my patient is not a “customer” or a “client.” We are not transacting business.
Which is why a doctor’s visit never feels complete without a physical exam. It is a crucial part of the doctor-patient relationship that cannot be underestimated. One doesn’t need a scientific study to prove that.
Oh, and sometimes the exam helps us make diagnoses. Unless we develop those skills, we are lacking and incomplete.
