I could not believe the recent discussion I read about the utility of a physical exam. Most patients expect an exam when they come to see a physician but the data and rationale for this feeling may be on its way out.
The example given is of a 60-year-old male with no chronic conditions and no current symptoms. He is up to date on his cancer screenings, feels well overall and has no complaints. He last saw a primary care physician 2 years ago. Routine lab work is ordered but should a physical exam be done on this patient? Here are the two schools of thought.
Yes, do the exam. Touch fosters trust and rapport. 452 patients surveyed at a VA center felt that the physician’s competence was directly related to the physical exam maneuvers. In a patient in this age group examining for evidence of atherosclerotic vascular disease or cancer would be important.
No exam needed. Some physicians argue that the physical exam has not been shown to decrease mortality or improve quality of life. Findings on a routine exam of this patient may lead to expensive and potentially dangerous tests.
There are many other pros and cons in this discussion that cannot be covered in this article. I am from the old school and feel that an exam by an experienced physician has significant benefit. I feel this way because I was trained before CT scanning and echocardiography and even flexible bronchoscopy.
My advice - take the exam.
