The Dying Art Of The Physical Exam

• metta
  
  Posts: 41607
  
  
  Sep 20, 2010 9:15 AM GMT

  The Dying Art Of The Physical Exam
  
  http://alturl.com/5wy38
  
  http://www.npr.org/templates/story/story.php?storyId=129931999&sc=fb&cc=fp

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• DCEric
  
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  Sep 20, 2010 1:43 PM GMT

  In before the obvious joke.

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• metta
  
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  Sep 20, 2010 4:29 PM GMT

  ^
  what?

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  Sep 20, 2010 4:36 PM GMT

  DCEric saidIn before the obvious joke.

  
  
  Obvious joke is not so obvious.

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  Sep 20, 2010 5:28 PM GMT

  In all honesty, the physical exam is being traded in for more lab and imaging studies. The biggest reason being that in the US, insurance and medicaid/medicare will foot the bill for most of the labs and imaging that you need. Does that make healthcare worse here?? Not at all. Are the doctors less competent??? Nope...its just one of those things.
  
  Where I went to med school, when you wrote an order for a simple x-ray (which is free w/ insurance and about 60 dollars without), you'd look at the patient and know that they can either get the x-ray/CBC/Liver Function Test or whatever test or they can feed their families. But under no circumstances can they do both. (Mind you, my rotations were done in a welfare hospital). As a result, we were forced to hone our examination skills to be pretty damn well sure that the workup we're ordering was absolutely necessary. Out teaching forced us to narrow out possible list of diagnoses down to 2 or three before proceeding with exams. Ordering a battery of tests was a luxury for us.
  
  One of the many MANY reasons I love this country so much. We should all be greatfull.

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  Sep 20, 2010 5:53 PM GMT

  DrNY saidAre the doctors less competent??? Nope...its just one of those things.

  
  Depends how you look at it. Less competent in interpreting physical exams? Yes. Less competent in overall diagnosis? No. In fact, newer generation physicians will almost certainly be able to provide better care through technology. However, because of this, there are going to be many areas where mediocre physicians rely on technology to provide marginally better care at 8 times the cost.
  
  Bottom line: lab tests are a double edged sword.
  
  

  DrNY said... a simple x-ray (which is free w/ insurance and about 60 dollars without)

  
  Nothing from an insurance company is ever free. They just hide costs. That's part of the reason healthcare is so expensive.
  
  I'm still waiting for someone to explain why everyone should have comprehensive insurance to cover the expected medical costs. If my house was hit by a tornado every year, I don't think I would be too worried about tornado insurance... Fire and flood maybe, but why would I want to automatically lose 30% of my money on an expected occurrence?
  
  Sorry about the tangent.

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  Sep 20, 2010 8:03 PM GMT

  DrNY saidIn all honesty, the physical exam is being traded in for more lab and imaging studies. The biggest reason being that in the US, insurance and medicaid/medicare will foot the bill for most of the labs and imaging that you need. Does that make healthcare worse here?? Not at all. Are the doctors less competent??? Nope...its just one of those things.
  
  Where I went to med school, when you wrote an order for a simple x-ray (which is free w/ insurance and about 60 dollars without), you'd look at the patient and know that they can either get the x-ray/CBC/Liver Function Test or whatever test or they can feed their families. But under no circumstances can they do both. (Mind you, my rotations were done in a welfare hospital). As a result, we were forced to hone our examination skills to be pretty damn well sure that the workup we're ordering was absolutely necessary. Out teaching forced us to narrow out possible list of diagnoses down to 2 or three before proceeding with exams. Ordering a battery of tests was a luxury for us.
  
  One of the many MANY reasons I love this country so much. We should all be greatfull.

  
  
  I disagree, I still think the physical exam should not be passed up and replaced by the expensive technological tests, its an adjunct not a replacement.. its just not the same reading off an MRI as is actually using all the senses to analyse a patient...
  
  The article is clear about it.. this pysician got so used to leaving out the PE that he missed the fluid buildup and completely passed up a lung cancer... you just cant replace a PE
  
  Now Im not saying we need to go back to tasting urine routinely to diagnose diabetes, but Im just saying if you are in a situation where the technology fails or is just not available to you... you're gonna have to rely on your senses anyway

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  Sep 20, 2010 8:04 PM GMT

  I liked this:
  
  
  "I sometimes joke that if you come to our hospital missing a finger, no one will believe you until we get a CAT scan, an MRI and an orthopedic consult. We just don't trust our senses."
  
  - Dr. Abraham Verghese

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