Many Daily Health News stories focus on what’s new in modern medicine (for better or worse), while many others explore ancient healing traditions — but today’s story is different from both of those. We’re looking back to the relatively recent past and discussing the demise of something so basic that it’s hard to believe it is fading away — the physical exam. The hands-on exam that doctors once relied upon as a diagnostic tool now seems positively quaint when compared with ultramodern, state-of-the-art technologies such as genetic testing and MRI scanning.
In medical circles, the trend is moving definitively in the direction of technology and the more the better — the thinking is that high-tech, in-depth electronic, chemical and nuclear tests can provide the information that doctors need with far greater precision than simple touch. But, according to Henri Roca, MD, medical director at the Greenwich Hospital Center for Integrative Medicine in Cos Cob, Connecticut, this may not be providing the best care for patients.
Dr. Roca shared his concern that today’s doctors are devaluing the physical exam. He told me that he is worried that our reliance on tests and technology has gone too far. “We’re so dependent on technology that it is as though we’re blind without it,” Dr. Roca said, recounting his experience working in New Orleans after Hurricane Katrina had decimated the area’s hospitals and medical clinics. “We didn’t have access to labs, CT scans or MRIs — and without the technology that modern medicine has come to rely on, many of the people who were the brightest shining stars in their respective fields of medicine were pretty helpless.” Dr. Roca added, “I’m not speaking against technology, but I am questioning whether medicine should come to rely solely on technology.”
According to Dr. Roca, the physical exam has benefits that can’t be overlooked, including…
It strengthens the doctor-patient bond. It’s impossible to overstate the importance of the relationship between a doctor and a patient, Dr. Roca points out, noting that it’s a way to establish “trust and security that will help healing occur.” Performing a physical exam means that a physician is taking the time to listen to you, to ask questions about your symptoms and to touch you instead of simply ordering a battery of tests.
It saves money. Dr. Roca readily admits that physical exams take time — much more than it takes to simply write a prescription for tests — but a comprehensive physical exam often can provide information that renders expensive tests such as MRIs and CT scans unnecessary.
It keeps symptoms in focus. According to Dr. Roca, a pitfall of sophisticated imaging studies performed without the contextual information of a physical exam is that they often deliver more information than actually is helpful, perhaps even identifying new issues that are distracting rather than meaningful. Dr. Roca said that these “incidental findings” can create anxiety for patients and lead to yet more invasive and expensive tests that ultimately prove unnecessary. For instance, he said, MRIs often reveal what appear to be abnormalities but are “normal findings for that patient — they aren’t the cause of the problem.”
It’s interactive. Today’s patients often are better informed about medical problems and treatments than those of yesteryear, but this can sometimes complicate a doctor’s work. For example, if you’re telling a doctor about a friend’s similar symptoms or discussing a fact or opinion you read online instead of your own experiences, you may omit important information that can help with a diagnosis, Dr. Roca said. If the doctor performs a thorough physical exam, he/she will notice relevant signs and question you about your symptoms in a way that gets to the root of the problem — even if the problem isn’t what you thought it might be.
Dr. Roca told me that there are three different types of physical exams, each of which has an important place in modern medicine:
And what should a patient expect with the aforementioned “thorough physical exam?” Dr. Roca says it should be a complete head-to-toe look. Though it quickly gets technical — each step has at least 10 substeps that look for various problems — at the very least your doctor should…
Dr. Roca urges people who feel dissatisfied with a doctor’s technique in performing a physical exam to voice their concerns. For instance, if you’ve complained about a symptom that your doctor hasn’t checked out, ask to have that part of your body examined. “This will require additional time, but it will lead to the experience that you want,” Dr. Roca said. The end result will likely be a more detailed physical and a stronger relationship with your doctor — and that’s a win-win situation.
