Blog | Friday, February 14, 2020

Can doctors still examine patients?


Does your doctor really know how to use a stethoscope or palpate your abdomen?

Today's physicians do not have the physical exam skills that our predecessors did. We can argue if this truth has diminished medical quality; I'm not sure that it has. But it has completely changed how medicine today is practiced. The reason for declining physician exam skills is that technology has largely supplanted physicians' hands, eyes and ears. In the olden days, the stethoscope was the diagnostic tool for examining hearts. I spent a month as a medical student with a legendary cardiologist who could make all kinds of cardiac diagnoses right at the bedside using 2 advanced medical instruments known as ears. Surgeons and gastroenterologists in years past had to make diagnoses of acute appendicitis and other abdominal emergencies based on feel and their ‘gut’. Neurologists made accurate diagnoses of stroke just using their clinical skills.

These days, there is really no need to be sleuth with a stethoscope since any murmur or extra click will be followed by an echocardiogram. I can't recall a case of appendicitis in my career that didn't involve a CAT scan to confirm a surgeon's suspicion. And, if a stroke is suspected, a head CAT scan will be arranged.

Since, medical technology has in many cases taken over the physical examination, doctors' hands-on skills have decayed. There is much less pressure for our exam skills to be superb since we know that some rescue scan or diagnostic test that does it better will follow. Conversely, if a physician were seeing a patient with stomach pain, and there was no technology available, I surmise that this doctor would do a more careful exam than he otherwise would. Get my point?

Are patients better served with more accurate technology to make and exclude diagnoses? Some have and many haven't. We all celebrate how technology in medicine has revolutionized the profession and has saved and improved lives. I rely upon this every day in my practice. But we must acknowledge that this progress has exacted many costs.

What's the harm with ordering a CAT scan? After all, it's non-invasive. Next week, I will address this issue in detail giving you a true “peek behind the curtain,” the raison d’etre of this blog. Feel free to offer your own thoughts on this issue on this post in advance of next week's full disclosure.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.