Recently a Kaiser Health News article http://www.kaiserhealthnews.org * noted: “Doctors at a Northern California hospital, concerned that a 40-year-old woman with sky-high blood pressure and confusion might have a blood clot, order a CT scan of her lungs. To their surprise, the scan reveals not a clot but large cancers in both breasts that have spread throughout her body. Had they done a simple physical exam of the woman’s chest, they would have been able to feel the tumors. So would the doctors who saw her during several hospitalizations over the previous two years, when the cancer might have been more easily treated.”
“A middle-aged man admitted to a Seattle emergency room for the third time in six weeks displays the classic signs of liver cirrhosis for which he has been repeatedly treated, including swollen legs and a distended abdomen. But a veteran doctor spots a telltale indicator of a different disease: rapid inward pulsations just beneath the man’s right ear. The patient’s problem is not his liver but his heart: he has constrictive pericarditis, a serious condition that requires surgery.”
“Both cases reflect a phenomenon that some prominent medical educators say has become increasingly commonplace as medicine becomes more technology-driven: the waning ability of doctors to use a physical exam to make an accurate diagnosis. Information gleaned from inspecting blood vessels at the back of the eye, observing a patient’s walk, feeling the liver or checking fingernails can provide valuable clues to underlying diseases or incipient problems, they say.”
“To address the problem, programs to revive and teach physical diagnosis – also known as bedside medicine – are underway at some medical schools, including Stanford, Jefferson and Johns Hopkins. The programs are predicated on a belief that these skills are an essential adjunct to technology and can boost diagnostic accuracy, curb unnecessary and expensive testing and foster a greater connection between patients and doctors, many of whom spend increasing amounts of their day staring at their computers rather than looking at the patients they are treating.”
“A Skill Set For Doctors
• Some components of a physical exam are familiar, such as listening to the lungs and heart, and assessing blood pressure and pulse. But parts of the Stanford Medicine 25 — a list of skills that the school considers important for doctors to know how to perform — may be less familiar. Below are some of those beside tests:
• Feel lymph nodes and differentiate benign enlargement from possible maligancy.
• Evaluate patient’s walk for signs of neurological or musculoskeletal impairment.
• Inspect the tongue for the presence of infection or underlying illness.
• Feel the thyroid gland and palpate the spleen to check for enlargement.
• Assess the liver, checking for tenderness and enlargement, and recognize signs of liver disease elsewhere in the body.
• Evaluate tremors and involuntary movements.
• Examine fingernails for signs of kidney, heart or lung disease or nicotine use.
• Check shoulders for range of motion.
• Evaluate knees for pain and movement.
* to read the full KHN article “Patients Lose When Doctors Can’t Do Good Physical Exams” by Sandra Boodman, highlight and click open hyperlink http://www.kaiserhealthnews.org/stories/2014/may/20/patients-lose-when-doctors-do-not-perform-physical-exams-correctly.aspx
Doctor, Did You Wash Your Hands? ™ provides information to consumers on understanding, managing and navigating health care options.
Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.
This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.