We have all been there. It often starts with some kind of recurring pain or dull ache. We don’t know what’s causing the pain or ache. During the light of day we tell ourselves that it is nothing. But at 3:00am when the pain wakes you… worry sets in – maybe I have cancer, heart disease or some other life ending ailment. The next day make an appointment to see your doctor.
Ok. Now you are sitting in the Exam Room explaining this scenario to your doctor. Based upon your previous experience, what’s the first thing your doctor would do?
- Order a battery of lab tests and schedule a follow up appointment.
- Put you in a patient gown and give you a thorough physical examination, including asking you detailed questions about your complaint, before ordering any tests.
If you answered A you have a lot of company. A recent post on KevinMD.com by Robert Centor, MD reminded me of yet another disturbing trend in the doctor-patient interaction. The post entitled “Many doctors order tests rather than do a history and physical ” talks about how physicians today rely more on technology for diagnosing patients than their own "hands on" diagnostic skills, e.g. a good patient history and physical exam.
Prior to the technology revolution in medicine over the last 20 years, physician training taught doctors how to diagnose patients using with a comprehensive history and physical exam. More physicians today are practicing “test-centered medicine rather than patient-centered medicine.” Medical schools focus on teaching doctors to “click as many buttons on the computer order set as we possibly can in order to cover every life-threatening diagnosis.” The problem is that medicine is still an imperfect science and technology is not a good substitute for an experienced, hands-on diagnostician.
The result of this move to “test-centered” medicine include: 1) more unnecessary tests are ordered, 2) patients are exposed to unnecessary risks (radiation, anxiety, etc.) and 3) health care costs go up.
Get Your Physician To Listen Or….Find A Physician That Knows How To Listen
Sir William Osler (1849-1919), considered the “most influential physician in history,” believed that the best diagnosticians were those that listened to their patients. The following quote attributed to Osler says it best – “Listen to the patient – he (or she) is telling you the diagnosis.”
So the next time you are sitting on the exam table provide a clear, before your doctor can interrupt you, present an organized history of your complaint. Ask your doctor to examine you before referring you out for x-rays or lab tests. If you doctor can make the case for tests after your doctor has heard you out…fine. This way you can be more likely of getting the correct diagnosis.
The Fading Art Of The Physical Exam. R. Knox, NPR September 20, 2010.
DeMaria, A. Wither the Cardiac Physical Examination? Journal of the American College of Cardiology. Vol. 48, No. 10, 2006.