The lost art of the physical exam (Yale Medicine Magazine, 2009)

“You have to rely on a detailed neurological or cardiovascular exam or just putting your hands on the patient,” he said. “That’s faster than getting a test result back.”

It’s also less expensive. Insurance companies are beginning to clamp down on such costly tests as MRIs unless a physical exam or some other finding justifies them. It’s a position that’s hard to argue with: it’s been estimated that approximately 80 to 85 percent of diagnoses can be reached via the history and physical.

https://medicine.yale.edu/news/yale-medicine-magazine/article/the-lost-art-of-the-physical-exam/

Very true. But. As MRI's etc gain traction as The tool, docs become less adept at hands on exams. They practice it less. Unfortunately.

I graduated from medical school in 1973. In the second year we had an intensive course in physical diagnosis, both lecture and practical, led by a certifiable master in the discipline. And for the remaining two years we practiced what we'd learned on real patients. Of course at the time we had no ultrasound, MRI, CAT or other advanced technologies so we had to be proficient at it. But I would have to agree, 85% of diagnoses can be made with good physical diagnosis techniques.

There was a book from the sixties or seventies called, 'the complete physical exam,' i think. by a doctor rosenthal. again, i think, im old.

but it was written by a GP for the general public to know what a doctor is doing and why. its a great read. very comprehensive.

now my wife's doctor never even looks at or touches her breasts. and the only pelvic is to take the pap test. no more checking for ovaries and the other things they look at. like the botholin glands.

things have certainly changed

Our textbook was Physical Diagnosis by Degowin and Degowin I believe. More than most people want to know but still available.

This subject goes two-fold. Yes, I think the art of physical assessment is a dying technique. This is not a good thing for medicine. So much can be gain from a proper physical assessment that can aid in formulating a diagnosis and differential diagnosis. Imaging studies should be used as a tool for diagnosis after a proper physical assessment to narrow down the cause of the patient's symptoms. On the other hand, providers today are paid on the volume of patients that the see so that's why it's a quick couple of questions and maybe cursory exam before heading straight to imaging and moving on to the next patient. This combined with more complex patient's, sicker patients today than decades ago contribute to this.

I have a university friend who teaches at a UK medical school. He's 64. He makes his clinical students (2 years from qualifying) come to extra classes early in the morning to learn physical exam skills they get less help with than 25 years ago.

He's an ear, nose and throat surgeon but the classes are for students before they specialise.

What he told me agrees with all the comments in this discussion about the importance of physical exam skills for young doctors.

PS They get free breakfast after the class.