Andrew Elder emphasises on importance of physical examination of a patient

CHENNAI

“If you don’t do a physical examination, you will make mistakes,” Andrew Elder, president, Royal College of Physicians of Edinburgh, told a large group of doctors and medical students.

Prof. Elder outlined the importance of physical examination of patients in the practice of medicine and went on to bust myths surrounding physical examination while delivering a lecture on “Why the physical examination still matters?” at the Government Stanley Medical College and Hospital on Wednesday.

“The problem is that doctors are losing their skills in physical examination, particularly in the U.S.,” he said. There is the other pandemic of over-investigation, doing too many tests, he said and added: “We are producing a form of medicine that no country in the world can afford.”

He pointed to the existence of models of physician reimbursement, determined by the number of tests ordered. “With more tests, we are becoming less and less confident in our own clinical skills,” he said.

So, what should physicians do? He pointed out that over a period of time, physicians based their diagnosis and treatment on observation. But when technology came along, they continued to gather clinical information, analyse and correlate with technology.

Talking about the contemporary physician, he said: “We are so blinded by the amazing tools that we are forgetting to look at the patient and examine them…We analyse rather than gathering and collating.” The value of the physical examination was not based on its diagnostic contribution alone. Noting that there is much more than that, he elaborated on care beyond diagnosis, patient contact, pedagogy and patient safety.

“Physical examination takes you to the bedside. That is where the patient is,” Professor Elder said. A surgeon in training watches his/her teacher operating. A physician learns by going to the bedside with the teacher and watches them. “These are skills that you have to acquire. Unfortunately, in contemporary bedside teaching, learners and teachers are not gathered around a patient but around the image of a patient such as ECHO cardiogram,” he said.