An interesting story about annual physicals appeared recently on NPR – The Fading Art of the Physical Exam. Some physicians have been “skipping” the exam and eliminating it from the regular procedures, and instead relying only on expensive tests to react to health concerns, rather than offering a good old-fashioned physical.
“…it appears that the trend is likely to get worse. ‘I’m definitely worried that the physical exam is dying a slow death,’ says Nesli Basgoz, a physician at Massachusetts General Hospital.”
The problem is some medical conditions are being missed because of the lack of a thorough, competent annual physical. Some physicians, however, are working diligently to reverse this trend.
“At Stanford, they’re trying to reverse the trend. The school’s graduates and trainees have to master 25 different bedside exam skills, from palpating a spleen to testing ankle reflexes.”
[Professor Abraham] “Verghese is convinced that doctors who know how to do a competent physical will pick up a lot of serious problems. ‘My worst nightmare,’ he says, ‘is that someone passes through my hands with a diagnosable, treatable condition that I missed because of sloppy technique. And they pop up six months later with somebody else at a point when it’s not treatable.’”
It is more than a mere ritual; it is a necessary part of good, proactive healthcare. It is the power of touch.
“And if you listen to the words people use, it’s very often, ‘He or she never laid a hand on me, he or she never touched me, he or she was hardly listening and they were busy entering stuff into the computer.’”
Take another perspective from an esteemed physician. Dr. Wendy Sue Swanson writes a blog entitled Seattle Mama Doc, and she recently posted an article entitled Wellness: 5 Words That Need To Be Spoken. In this post, she discusses her observations of an oncologist during an appointment with her mom who just finished chemotherapy.
“The oncologist joined us. When he came in, he sat on the stool where he always does. Put his hands on the keyboard like he always does. Planted his feet in just the same way as his laces lay as they always do. But then he did something he’s never done before. He looked at my mom and he said,
‘You’re the picture of health.’”
As Dr. Swanson said earlier in her post:
“We physicians need to remember to proclaim precisely what we see. Wellness, like illness, should be detailed.”
Healthcare needs to remain personal, the art of touch and words.
In all the hurried implementations of EHRs and putting technology in place to gain HITECH incentives, the simplicity of these two elements is essential to keep at the forefront of everything that is done.
Maybe that is why physicians are beginning to hire scribes to put patient data into the EHR. According to a recent article in the LA Times, Scribes are Doctors’ Tech Support, scribes are being hired to increase physician productivity with EHRs but to also increase the amount of quality time physicians spend with patients.
“’The physicians were spending too much time documenting and not enough time with the patient,’ said Dr. Robert Steele, chief of Loma Linda’s emergency department, which began using scribes in November. ‘The solution was to take the doctors off the computer, put them at the bedside, and let the scribe do the transcription. It’s been a huge success. The physicians love it.’”
Although there is some irony in having to hire a person for $8 and $10 per hour in order to move patient health records to an electronic system, the end result seems to be positive – better physician and patient interaction.
Getting physicians and patients discussing how to enhance one’s health is a positive development.
Getting patient data into an electronic system is also a constructive development.
It seems win-win to me. Technology, people, patients, better annual exams, words exchanged – all intertwined to personalize healthcare while delivering better care. It is empowering patients and physicians.
Update: In light of this post, we recently polled our readers to see when they make the decision to visit their primary care physician for an annual exam. The results from the poll can be found here.
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