Reflecting on the Value of the Physical Exam
“What is a physical examination worth?” asks primary care physician Paul Hyman of Mid Coast Medical Group in a JAMA perspective piece. The recent surge in telemedicine has prompted Hyman, along with many healthcare providers, to reflect on the tradition of examining their patients in person. In his essay, Hyman explains the “physical examination has been ripped away” from his practice, inspiring a revelation about its value for two key reasons.
First, Hyman echoes a sentiment he knows has been long shared by Stanford Medicine 25’s Abraham Verghese: the physical exam acts as ritual that holds comfort and meaning for patient and provider. With the large-scale and rapid transition to telemedicine, the author says only now does he recognize the exam as a source of calmness and confidence for both parties, as well as a tool for creating human connection and establishing an accurate patient narrative.
Second, as shared in a conversation with NPR’s Kristen Kendrick, Hyman emphasizes that the physical exam often reveals a critical piece of science or data that informs “what should happen next.” He cites heart failure which could cause fluid buildup in a patient’s body. To make an accurate diagnosis in this scenario, it’s critical that the physician is able to touch the patient, listen to their heart, legs, take their blood pressure and look at the veins in their neck, or something may be missed.
Although today’s climate has forced physicians to rethink the physical exam, Hyman notes that “not all is lost with the emergence of telehealth” as virtual visits lend themselves to new avenues for patient connection. For example, he says, visits over a screen tend provide greater insight into factors that influence a patient’s health behaviors, which, in turn, can help treat illness in a way that aligns with the individual’s overall priorities.
As advocates for the physical exam, we are closely following this digital transformation in medicine and, like Hyman, acknowledge that telemedicine will likely continue to grow. We recently discussed strategies for overcoming challenges presented by a technology barrier and agree with Hyman when he concludes that physicians must now optimize new ways to gather data which were traditionally provided by this essential aspect of patient care.
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Peter Conrad, a sociologist at Brandeis University, spoke of the rise and fall of the medical authority in the doctor patient office encounter in his many scholarly articles. With the internet becoming the “elephant in the doctor’s office,” the dynamic of medical authority has certainly changed…