The Physical Exam

Recently I visited the urologist. I was getting a consult to follow up with a previous diagnosis given to me after a night in the Emergency Room. I have kidney stones. For the exam, if you could call it that, I remained fully clothed. My temperature wasn’t taken, my blood pressure not checked, I wasn’t touched by the doctor a single time, not even to shake hands.

This isn’t uncommon.

I didn’t need a physical exam, but I was in pain, I desperately wanted the Physician to check my back and the pain near my kidney. I wanted the doctor to ask about the strange symptoms I was experiencing for the first time; but she didn’t.

What is the importance of the physical exam?

Doctors of old are pictured standing over their patients, listening to the heart, lungs, and stomach, sometimes with their ear. It was a ritual of care, love, and empathy.

The Doctor exhibited 1891 by Sir Luke Fildes 1843-1927

The Doctor exhibited 1891 by Sir Luke Fildes 1843-1927

The painting above is titled The Doctor, and was painted by Sir Luke Fildes in 1891. In it a doctor is seen anxiously poised over a gravely sick child. His face conveys a powerful mixture of confusion, fear, and empathy. In the background we see the child’s father watching the doctor and the mother with her head on the table, her obvious despair well out of the child’s view. From the parents position within the painting we see a situation of great trust. It is the doctor, not the parents, who has the responsibility of taking care of the child.  What a profound position, a position that deserves respect.

When I volunteer at medical clinics, regardless of what the patient is there for (whether it be a cough, a rash, chest-pain, or depression) I will look into their eyes and ears, listen to their heart, and ask them to say “ahh”. Why? Because it makes them feel better, and I’ve heard enough testimonies to convince me.

Today, the patient has been replaced by a computer screen, printed test results, and x-ray images.

There is no question that our diagnostic abilities have improved. But what have we lost with the abridged physical exam? Dr. Verghese argues we are missing diagnoses, and this very well may be true. What we can say with certainty, however, is that we have lost the position of care pictured above. There is no substitute for a physician’s touch and the impact it has on the emotional and physical well-being of the patient.

Next time I go for a checkup, I’ll make sure to ask my doctor to listen to my heart and i’ll explain the weird pain i’ve had in my side, or that unpleasant symptom that has stuck around a week too long. I won’t be shocked when they seem antsy to leave and be with their next patient, but perhaps my persistence will trigger something in my doctor. Hearing about my pain might make me a little less of a test result or x-ray image and instead I will become a flesh and blood patient and the doctor will assume the position of empathetic patient advocate once again.

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