Despite a foothold in medicine that predates Hippocrates himself, the traditional physical exam might be on the verge of extinction. The coronavirus crisis has driven more routine medical appointments online, accelerating a trend toward telemedicine that has already been underway.
“I think there’s something therapeutic about seeing a physician and having them lay their hands on you, and my sense from the feedback I’ve gotten from the article already is that a lot of people agree that it’s therapeutic in its own right — and that can be lost without the physical exam,” Hyman told NPR.
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It does give me, for some patients, a lot of insight into the way they live their lives and what their home or work environment is like, which can help me understand more about where their health concerns fit into their overall priorities. I think it’s helped me connect with patients in different ways.
What else is lost in the doctor-patient relationship when you can’t do physical exams?
There’s something about coming into the office and going through a history and being examined — and that ritual provides real comfort and meaning to both a physician and to the patient.
The exam is an objective piece of data. The patient has a narrative of their illness that the physician is trying to understand to help them feel better, but then the patient may think one thing is going on and the physician may think another. The exam can really be helpful as a piece of science or data that helps clarify what should happen next.
Are there instances where a virtual visit provides a better environment?
Sometimes patients can be distracted, doing other things. But there are opportunities in the virtual visit to actually really connect and listen without some of the distractions of a busy office and an exam room. We still have to remember that most of what we’re going to learn about a patient’s illness is going to be through listening to them.
Has the business of medicine already started to devalue a doctor’s touch?
I think what is devalued is humanistic interaction between a patient and a physician — development of a relationship and good listening.
Less time with patients seems to be the enemy for doctors, both virtually and in person.
Yeah, time is the most critical part. And we’re just getting less and less of it. I just got an email from a doctor, a pediatric specialist, about how he always does a very complete physical exam because he needs, as we’ve learned in medical school, to take a step back, think about the big picture and not miss something. That mindset is not valued in the current situation.