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Losing Touch with the Physical Exam

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 28 in the December 5, 2012 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.

Choosing a family physician for many is like picking a sibling. It takes time to get to know them and be able to share the information that affects one health. Sometimes the fit is not right.One of the traditional elements in this process was the annual physical exam. It was a time for relation building and to better understand health concerns. In an effort to save money, it is now being replaced by a modified briefer, age-specific interaction.

The traditional health exam was a time to get to know patients, look for problems, feel, touch and listen in order to evaluate health. Most patients were found to be in good health, with only minor improvements needed, a conclusion that without repeated findings of severe disease is resulting in its extinction. Often this time was spent listening to the minor problems and issues heavy on the heart that often defined what the doctor patient relationship is about. It was a type of one-stop shopping in which numerous minor problems were addressed. In what I believe is a mistaken bid by both physicians and government, it has been proposed to eliminate this process, and replace it with a more technical, briefer and pointed process designed to look for positive findings. Less talking and touching and more testing in brief. With students, we usually assigned a full hour for a physical exam and expected most of the interaction to be a verbal one getting to know the health needs of a stranger. It is this aspect that can lend reassurance to a health problem.

To illustrate the change, a 30-year old female may be sent for some blood testing, have a pap smear done, urine testing and a quick cursory look for moles and few other things. A 60-year old woman may receive a shot, Pap test, blood test, mammogram, stool testing for blood, and maybe a heart test or bone density. Most primary practitioners already feel the pressures of time constraints, and this will only add to it. The decision is based on science that measures major disease and solid end points such as death age, rather than wellness level or life satisfaction. Many patients with ongoing health problems such as heart disease, diabetes or hypertension are seen on a regular basis, and other things tend to get diagnosed during those visits. Many of our traditional "physicals" are performed on people who are determined to preserve good health through healthy living. The process lends reassurance of both the soul and body and prolongs good health.

The reliance on batteries of tests and technical machinery is part of a historical circle dating back thousands of years. Hippocratic physicians prodded, poked and questioned. Understanding meant knowing the entire patient. The process was lost to history and did not re-emerge till the middle ages. To diagnose means learning the patient's habits, diet, work, etc. To find this process in the realm of political negotiation is truly sad.

Related resources:

Re-thinking the Annual Physical from Science-Based Medicine. Published by Harriet Hall under Uncategorized Comments: 85. 21 Feb. 2012.

Danish study finds annual physical exam unnecessary, possibly stressful by Denise Dador, Healthy Living, 17 Oct. 2012. Video 2:22 min. "A new report may have doctors and patients re-evaluating the traditional concept of the annual physical exam."

Abraham Verghese: A doctor's touch. Filmed Jul 2011, Posted Sep 2011. Video, 18:32 min. "Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. Physician and writer Abraham Verghese describes our strange new world where patients are merely data points, and calls for a return to the traditional one-on-one physical exam.

In our era of the patient-as-data-point, Abraham Verghese believes in the old-fashioned physical exam, the bedside chat, the power of informed observation."

Annual Physical Examinations from WebMD. "For some people, having an annual physical examination is a source of reassurance that they're as healthy as they feel. Others see it as an alarm system, to catch health problems before they become serious.
The value of the routine annual exam has been debated recently, but it remains a cherished tradition among many doctors and patients . . .

Do You Even Need An Annual Physical Exam? . . . studies show that the actual exam isn't very helpful in discovering problems and may lead to unnecessary tests.
Leading doctors and medical groups have called the annual physical exam "not necessary" in generally healthy people."

Annual Physical Exam by Benjamin Wedro, MD, FACEP. Medical Editor: Melissa Conrad Stöppler, MD FAAEM, from Medicine Net. "Medicine is a schizophrenic profession trying to balance art and science. It gets especially difficult when the science half tries to prove the art of little value. Doctors from the University of Pittsburgh and Stanford University have decided that the annual doctor's visit may be a waste of time."

Annual Physical from Healthway Medical Philippines. Annual Physical Exam (APE) - Basic 5 include: a. Full medical exam. b. Complete blood count. c. Stool exam. d. Urinalysis. e. Chest X-ray.

Why the annual physical exam is essential to both doctors and patients by Steven Reznick, MD, 22 June 2011, in Physician. "I have listened to health economists debate the value of an annual physical exam. Is it cost effective? Does it prevent disease? It doesn't matter. It is an essential part of the development and continuation of the doctor patient relationship.

The annual physical exam is a form of benchmarking. It allows the doctor and patient to review all the pertinent aspects of your health history and physical exam and use the data to coordinate a care plan for you which is personalized."

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