Is the physical exam facing extinction?

Many doctors are truncating the physical exam or just skipping it altogether, NPR reports. It seems the days of doctors poking, prodding, peering, sniffing and listening to a patient's body may be fast disappearing.

Senior Cardiologist Roman DeSanctis at Massachusetts General Hospital told NPR he is always amazed to learn when his patients' doctors have not examined them. In one recent case, he heard the sounds of an abnormal fluid buildup in the chest of a patient who turned out to have lung cancer. Strangely enough, another doctor he had seen before DeSanctis had not "really examined" him.

Physicals can help a physician identify problems that the patient didn't know about before they become much harder to treat. From that standpoint, a physical exam could help cut costs. But a tendency to rely more on tests and other diagnostic procedures is more pronounced these days.

"I sometimes joke that if you come to our hospital missing a finger, no one will believe you until we get a CAT scan, an MRI and an orthopedic consult," Dr. Abraham Verghese, a professor at Stanford Medical School, told NPR. "We just don’t trust our senses."

Stanford is trying to reverse the trend away from physical exams by requiring the med school's graduates to master 25 different bedside exam skills, which include detecting fluid in the abdomen and abdominal blood flow and testing ankle reflexes for nerve abnormalities.

Critics say that it's more important to talk to the patient and note that some tests are much more accurate than the physical exam. A recent New York Times article that seems to endorse physical exams even notes that for a healthy person, an "abnormal finding" on a physical exam is more likely to be a false positive than a real sign of illness.

In the often heated comments that follow the NPR story, one doctor notes that in his experience, med schools are cutting courses that emphasize traditional and cheaper forms of analysis in favor of "blackbox" techniques. Another commenter says he sees a trend toward irrelevant, but rote mechanized procedures.

Another physician who commented calls the article one-sided. If it is a truism of medicine that 90 percent of diagnosis is accomplished by talking to the patient, he writes, "...if anything, doctors should spend more time talking and less doing routine physicals."

To learn more:
- read the NPR article
- check out this New York Times piece

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