The Physical Exam and Other Forms of Fiction

Abstract

The traditional physical diagnosis course taught in the first two years of medical school has changed little in over half a century, and it deserves some scrutiny, if only because it is quite out of step with what students see when they begin on the wards during their clinical years. They are surprised to find that the house staff and attending staff carry very few of the instruments the student has acquired: reflex hammers are occasionally spotted, but ophthalmoscopes are quite rare. Even more vexing for the student is the realization that the currency on the ward, the “clinical skill” they were so anxious to acquire, does not involve the patient as much as it involves finesse and efficiency on the computer in ordering tests, in discharging patients and in completing notes-throughput. Indeed, one could make the case that it is time to dispense with the physical exam course altogether because the physical exam is being dispensed with altogether. It would appear that the two-dimensional rendering of the patient through imaging occupies us more than the three dimensional reality of the patient.