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I have been thinking lately that the art of the physical exam has somehow been lost. MD’s today seem to totally rely on modern imaging and lab work rather than actually touching the patient. This occured to me as I was by a physician who literally palpated every organ he could. He listened and tapped and poked and prodded. This was a first visit for me and I found it refreshing that there exists someone who actually knows how to perform a real physical exam. I don’t think I have had a physician do that since I was a kid. Of course imaging and blood work have their place but many doctors I have observed never seem to touch their patients save for a quick listen with the scope. I have many tomes on the physical exam as I had to learn it myself. I once percussed a patient and the attending kind of chuckled and said that no one does that anymore. I don’t know. Shouldn’t a doctor know how to complete an actual physical exam instead of ordering expensive tests? I’ll bet it would save loads of Medicare and Medicaid dollars.
You must either be a PA or a NP. Either way, when did you finish school? It must be a long time ago. Anyway they still teach PE in school. They still teach percussion, but not many providers do it.
Today because of time constraints, most of us do focused PE’s. I’ve gone personally for that type of PE myself, where the provider does a ton of hands-on. But he charged good money and it took a good amount of time and it was his practice. In the reality of most exams, whether an ER or Primary Care office, you have very little time to do all you have to and move on. Most of the diagnosis will come from the history anyway. Of course, there are always those that basically skip the PE, just take a quick listen with the scope, and this is also wrong. You need to do a PE, even if it’s just focused and most do. As far as tests go, a practioner should only order tests that might be revelant. But again a lot will order everything under the sun because they are afraid of a lawsuit. I personally won’t, but a lot will. This issue is actually a hot potato in Congress. A lot of politicians are calling for tort reform, so providers will stop ordering anything they can think of. This, like you said, will lower the costs to the insurance provider!
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