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Changing The Feel Of The Physical Exam

I suffer with herniated lumbar disks.  L4-L5 bulges and ruptures on occasion.  If you catch me on the wrong day I have a little curvature to my back representing the spasm that makes me miserable.

I saw an extremely well-referenced orthopedic surgeon in consultation recently.  But 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 first hand 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.

How very sad,” they say clutching to their black leather bags.  “What would Osler think?” Not sad.  Different.  The way we examine patients is changing.

So what will become of the physical exam?  What role will touch have as medicine becomes more precise?

As physicians we originally touched to understand patients.  The ritual and mystery of the exam had the added feature of leading patients to believe that so much could be understood with our hands.  But many exam maneuvers were more relevant at a time when there was no better way to understand a patient.  Now we romanticize touch and all that it once represented.

Advanced diagnostics will continue to change the relationship we share with patients.  Technology will separate us while at once creating the opportunity for a new type of connection.  And I suspect that touch will ultimately evolve to fill a deeper, non-diagnostic role.  It’s purpose and meaning will be very different a century from now.

Many struggle with the separation.  But perhaps we will need to move further away from patients before we can truly understand the importance and meaning of human contact in medicine.  Brian Christian in The Most Human Human suggests that “the inhuman has not only given us an appetite for the human; it’s teaching us what it is.” Perhaps the automation of medicine will help us understand our true role.  Machines may ultimately help us learn what constitutes a real human connection.

Link to The Most Human Human is an Amazon affiliate link.

*This blog post was originally published at 33 Charts*


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