The lost art of the physical exam   2 comments

Hi All:

On NPR today, Dr. ABRAHAM VERGHESE, Professor for the Theory and Practice of Medicine, Stanford University Medical School; Author, “Cutting For Stone” lamented the loss of a hands on physical exam.

Points to ponder from the interview:

“I’m not a luddite, and it’s not that I don’t like technology, but there really are so many things that are quite self-evident on the body if you only look.” This speaks to the idea that technology and medicine are opposed to one another. Will doctors who use EHR pay even less attention to patients?

“I’ve become more convinced that a thorough physical in the context of a new patient or a patient at the hospital is a very symbolic act. I mean, if you think about it, here’s someone telling you their deepest, darkest secrets and then disrobing and allowing touch – which, in any other context, would be assault. And I think that our skills have to be worthy of this very sacred ritual.” 

” I come to think of it as a way of taking their story and giving it body.”  This sent me back to Groopman and Montgomery.

“it’s almost as though the skills of 150 years have atrophied when, in fact, they should be a hundredfold better” This too made me think of Montgomery’s ideas about clinical judgement versus the logic tree method of medicine.


Posted October 15, 2010 by elleok in Uncategorized

2 responses to “The lost art of the physical exam

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  1. Very interesting–and relevant to the use of simulation technologies that we’ll learn more about today.

  2. Elle, very interesting discussion. I had the same physician from the time I was born until I was in my early twenties, and I remember clearly when he retired and a young doctor took over his practice. My first “physical” with the new doctor was so different, I even asked him “is that all there is?”

    The physician I left recently when I lost my job and insurance was also old school (and also from another culture–I wonder if there is a connection?). His exams always included the significant body touch and observation that Dr. Verghese mentions. I think it would be very interesting to be a standardized patient and experience what we are teaching our new doctors.

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