Physical examination is becoming a lost art and used less and less as technology driven medicine replaces clinical assessment. A recent article in the Washington Post highlighted the waning ability of doctors to use physical examination to make an accurate diagnosis. Over the past few decades, the physical diagnosis skills of physicians has decreased while the use of a dizzying array of sophisticated expensive tests has increased dramatically. Many healthcare organizations downplay the physical exam and think it superfluous compared to medical testing. Often, however, when technology is used without bedside skills, it takes the physician down a path where tests cause more tests to be ordered and, at the end after all the delay, the patient either sees a surgeon, a lawyer or an undertaker.
The art of physical diagnosis needs to be revived and used as part of modern medical practice. Medical testing should be used to confirm a suspected diagnosis, not to make the diagnosis. “Diagnostic imaging” is a misleading. Doctors should not order a test to “see what it shows”. The diagnosis of cancer, heart failure, cardiac problems, diabetes and high blood pressure all have signs that are often apparent on physical examination without the necessity of expensive tests. Testing has a role to determine the severity of disease, but suspecting the diagnosis should be made by the physician’s clinical skills. However, it is easier for healthcare insurers to pay for an expensive test than to pay the doctor for time spent in clinical information gathering and decision making.
Britcher Leone & Roth understand that cancer misdiagnosis and delayed diagnosis of many conditions can lead to devastating injury. The need for physicians to take time to elicit information and to use their clinical expertise remains an important part of medicine that is being diminished to the detriment of patients. The error rate for primary care, where the time pressure is perhaps the greatest, estimated at 5%. As more patients go into Medicaid under the ACA, the pressure to order tests instead of spending time that goes unreimbursed will only grow. This does not bode well for the health of patients and the financial health of our healthcare system.