Are Physical Exams Just Theatre?

Are Physical Exams Just Theatre?

Learning the age old art of physical examination used to be an essential part of 1st year medical education. Not any more.

Technology has changed that. "We're now often doing expensive tests, where in the past a physical exam would have given you the same information," says Jason Wasfy, a cardiologist-in-training at Massachusetts General Hospital in Boston.

As a result, many doctors are abbreviating the time-honored physical exam -- or even skipping it altogether. Or, maybe they continue to do it, but for the wrong reasons.

  1. In an editorial recently published in The New England Journal of Medicine, Drs. Ateev Mehrotra and Allan Prochazka explored the complex issues surrounding annual physical exams. In the name of improving “value” in health care, they argue that these routine visits should not continue.
  2. Telemedicine is diffusing into the practice of medicine and much of the diagnosing and treatment is done without a physical exam or uses remote sensing devices.
  3. Executive health physical exams have dubious value whether or not the physical exam in thrown in as part of the $5000 tab

Electronic stethoscopes might improve what doctors hear, but research still needs to be implemented to validate the digital stethoscope as a way to increase value or eliminating the need for additional tests.

Eko, a maker of high-end digital stethoscopes, has just received the first FDA clearance for its devices to use AI algorithms to automatically detect atrial fibrillation (AFib) and heart murmurs. Using this capability, primary care physicians, who are not nearly as extensively trained at spotting heart issues, will be able to identify potential cases of AFib, as well as valvular and structural heart diseases, with an accuracy similar to seasoned cardiologists.

The physician’s workflow remains practically the same as using a conventional stethoscope, except that Eko’s devices, which include a built-in single-lead ECG monitor, send their readings to a paired smartphone that displays what Eko’s AI thinks about the data

  1. Stethoscopes carried by health care practitioners are loaded with diverse bacteria, including some that can cause healthcare-associated infections, according to a study. Maybe getting it off your neck is not such a bad idea after all.

6. While there are certainly examples of physical exam altering diagnostic accuracy, most medical students are taught “Listen to your patient; he is telling you the diagnosis.” Of course Osler said that over 100 years ago when he had more than 20 minutes for a visit, no EMRs , and no billing code compliance time sucks.

7. Even if you have a doctor use a stethoscope or perform a physical exam, it is unlikely that he or she will be competent to do it. Several recent studies document the decline in physical examination skills among physicians. When do you think was the last time your ophthalmologist or otolaryngologist used the stethoscope the drug company gave her at graduation?

8. Many physical exams are done so doctors can document they did them so they can bill for doing them even if they listen to your lungs through three layers of clothes.

9. Many physical exams are so perfunctory (shine a light in your throat and say "ah", put a stethoscope on your chest, feel your abdomen, strike your knee with a reflex hammer) as to render them useless and merely therapeutic theatre.

10. It is a last chance way to put some high touch into the visit.

Yes, the laying on of hands has some therapeutic value.

Just make sure you wash them. They might have coronavirus on them.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on [email protected] and Facebook,

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  • Luke Abraham

    Funny conclusion, but this is so true :)

  • Sharon Turner

    Healthcare has evolved....

  • Marty Hewitt

    You are absolutely right Dr Meyers.

  • Glenn Donnelly

    Robot doctors will replace surgeons

  • Sophia Billett

    I don't know if you will read my comment but I love your posts. They are so simple and easy to understand. I like your innovative approach towards medicine and health care.

  • Kumar Mohit

    Good article

  • Ross Pearl

    Interesting question

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Arlen Meyers, MD, MBA

Healthcare Expert

Arlen Meyers, MD, MBA is a professor emeritus of otolaryngology, dentistry, and engineering at the University of Colorado School of Medicine and the Colorado School of Public Health and President and CEO of the Society of Physician Entrepreneurs at www.sopenet.org. He has created several medical device and digital health companies. His primary research centers around biomedical and health innovation and entrepreneurship and life science technology commercialization. He consults for and speaks to companies, governments, colleges and universities around the world who need his expertise and contacts in the areas of bio entrepreneurship, bioscience, healthcare, healthcare IT, medical tourism -- nationally and internationally, new product development, product design, and financing new ventures. He is a former Harvard-Macy fellow and In 2010, he completed a Fulbright at Kings Business, the commercialization office of technology transfer at Kings College in London. He recently published "Building the Case for Biotechnology." "Optical Detection of Cancer", and " The Life Science Innovation Roadmap". He is also an associate editor of the Journal of Commercial Biotechnology and Technology Transfer and Entrepreneurship and Editor-in-Chief of Medscape. In addition, He is a faculty member at the University of Colorado Denver Graduate School where he teaches Biomedical Entrepreneurship and is an iCorps participant, trainer and industry mentor. He is the Chief Medical Officer at www.bridgehealth.com and www.cliexa.com and Chairman of the Board at GlobalMindED at www.globalminded.org, a non-profit at risk student success network. He is honored to be named by Modern Healthcare as one of the 50 Most Influential Physician Executives of 2011 and nominated in 2012 and Best Doctors 2013.

   

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