Is the Physical Exam a Dying Art?

October 15, 2010

Physician and author Abraham Verghese, of Stanford University, thinks physical examination skills are being lost, and he's on a mission to save them.

Is the physical exam a lost art? And should it be revived?

Physician and author Abraham Verghese, of Stanford University, thinks so, and he's on a mission to save the physical. (If his name sounds familiar, his novel "Cutting for Stone" is on the best-seller list, and I found it to be a beautifully written book.) In an article this week in The New York Times, Verghese makes a case for the physical, which he says is being pushed aside by the likes of countless lab tests, CT scans, and ultrasounds.

Dr. Verghese, who trained in Ethiopia and India, says he has encountered residents in the U.S. who don't know the intricacies of the physical exam. "He still believes a thorough exam can yield vital information and help doctors figure out which tests to order and which to skip - surely a worthwhile goal as the United States struggles to control health care costs, he said," according to the article.

Dr. Verghese has lectured and written about the importance of the physical exam, and developed with colleagues the "Stanford 25," a non-exhaustive list of techniques every doctor should know. In their explanation of the 25, Verghese and his colleagues write:

"In the absence of a high-stakes clinical bedside final exam (as opposed to a high-stakes multiple choice exam), there is little impetus for people to learn and master bedside skills - truth is, you can be board certified in internal medicine and no one has really ascertained that your technique in doing an ankle reflex allows you to accurately say a reflex is truly absent. (You will be surprised how most ‘absent’ reflexes become ‘present’ when you learn good technique.) Does it matter? It does to us."

Their site includes videos and information about the 25, intended to be a refresher resource for those who have had hands-on sessions.

What do you think - is the physical exam a dying skill? If so, what can be done to bring it back?