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The Physical Exam

Posted Aug 26 2008 4:09pm
I was always taught that the physical examination was the most important part of the patient visit. Dr. Rob at Musings of a Distractible Mind just pointed out the diagnostic value of the "laying on of hands". But my teachers, back in the day, used to emphasize how reassuring it was to the patient.

I am always pleasantly surprised by my patients when they say I had done a more complete exam than they'd had for years.

Really? But with high blood pressure, diabetes and heart disease, you must be in the office every other month?

Why do I have to justify NOT doing an echocardiogram when it has all the features (new, soft, disappears on lying down, no ra diation) of a benign murmur? Why did my service chief give me a congratulatory call a few years ago for picking up an abdominal aneurysm when a resident overlooked it (it was obvious)? Why do I find lymph nodes in the posterior chain that nobody else seems to look for? Some of my former teachers believed I was barely adequate at physical diagnosis. I have trouble taking compliments now.

Physical examination provides diagnostic accuracy and reduces the cost of unnecessary testing. More importantly it increases the patient's confidence and enhances the relationship.

But why listen when you can order a scan?
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