Tuesday, January 31, 2012
Touch me or touch me not?
A tug-of-war is going on in medicine right now between the past and the future. The present is confused and very unsure of itself.
Though I could be writing about health care in the U.S. and the looming Supreme Court battle over the new health care law, I'm actually raising a much more intimate issue: Whether your doctor touches (examines) you or not.
Many pundits have weighed in on whether the physical exam has utility in an age when we have machines that can look inside the body and evaluate its physiology as never before.
Others have suggested that regardless of an exam's diagnostic capabilities, performing a physical has intrinsic value: connecting with patients. It's what they (you) expect. Touch is inherently therapeutic and offers solace.
Medical schools still teach the ancient art of the physical exam:
Inspection. Looking at the patient.
Palpation. Touching the patient.
Percussion. Tapping the patient's torso (chest + abdomen) to locate organs and detect extra fluid if present.
Auscultation. Listening with our stethoscopes.
These artful skills originated as far back as Hippocrates (though it wasn't until 1821 that Laennec invented the stethoscope).
Listen to the talk from Dr. Abraham Verghese (Stanford doctor and author of the novel Cutting for Stone) about the rise of the iPatient and his call to return to fundamentals--not only as good medicine but as effective and therapeutic medicine.
Contrast Dr. Verghese's approach with the experience of Dr. Bryan Vartabedian, a gastroenterologist, blogger, and social media authority from Texas.
Dr. V has a history of herniated lumbar disks. He visited an orthopedic surgeon for a consultation, and this is what he wrote about his visit: "... through the course of my visit he never touched me. We spent an extraordinary amount of time examining my MRI. Together in front of a large monitor we looked at every angle of my spine with me asking questions. I could see firsthand what had been keeping me up at night. I could understand why certain positions make me comfortable. What we drew from those images could never be determined with human hands. In my experience as a patient, I consider it one of my most thorough exams."
The contrast between the two experiences and the reactions to them could not be more profound. It leaves me wondering what the most important elements of doctoring are to pass along to my trainees. Losing the physical exam seems blasphemous. Yet sometimes I'll admit it feels more like hocus pocus than a meaningful endeavor.
What are your views? Is it necessary for a doctor to touch you on each visit? Is a yearly physical crucial? Would a consultation with a doctor be valuable if all you did was talk?
This post by John H. Schumann, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.
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