Last week, Dr. Abraham Verghese gave a speech titled similar to that above as part of the Tanner Lecture Series. I was lucky to spy the ad in the free local rag at the coffee shop and then lucky enough to score one of the last tickets!
Verghese is the author of the popular Cutting for Stone as well as numerous articles extensively discussing the lost art of the physical examination in medicine. He touched on this theme again, drawing attention to the ritual nature of the physical exam. He recounted a personal experience of “disembodiment” in the preop holding area while waiting for a surgical procedure… I remember feeling this way during my stay in the hospital. Very few of the many doctors who took care of me and consulted on me actually performed a physical exam!
Yes, in our era of advancing technology with numerous diagnostic tools at our disposal (in addition to the fact that the increasing rate of obesity precludes reliable findings), the physical exam has much less diagnostic value. However, the value is in the connection between doctor and patient when touch becomes part of the interaction. I would like to posit that this connection not only benefits the patient in the obvious ways of enhancing care and gaining trust in the physician’s expertise, but it benefits the physician in the manner of reinforcing our roots in medicine. These kinds of intimate interactions are part of why we chose to pursue medicine in the first place!
The lecture also reminded me that personally I am very fortunate to have a job where I can completely focus my efforts on the patient. As a purely clinical anesthesiologist in an academic practice, I don’t have a clinic or office where I have to worry about production/time pressure and economic constraints. Nor do I have academic commitments that force me to spend energy on administrative or publish/perish type politics. It’s truly a gift, but I also consciously chose the job over other opportunities because it was most in keeping with my personal values and goals. So far I’m loving it!