The Routine Daily Physical Exam: Worthwhile or Waste of Time?

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By Lanna Felde, MD |  November 22, 2021 | 

Last week’s #JHMChat saw an all-star guest lineup including Drs. Adam Rodman, Zahir Kanjee, Laura McNamara, and Shane Warnock of Beth Israel Deaconess Medical Center debating the value of the routine daily physical exam – is it worthwhile or a waste of time? This question was recently debated in our Point: Counterpoint series and got our readers fired up on both sides of the issue.

Team Pro-Exam argued that performing the physical exam builds trust and credibility and that patients have more confidence in physicians who perform a more thorough exam. Dr. Hadmon commented that the exam represents an opportunity to build trust simply by communicating to the patient and family the purpose of our diagnostic maneuvers. Dr. McNamara reported that patients sometimes open this line of communication with questions like, “How do my lungs sound, doc?”

Dr. Kanjee strengthened the argument that the physical exam builds trust, noting that patients’ perceptions of their primary doctor are correlated with the number of exam maneuvers performed. Dr. Unaka shared her personal experience of feeling “unseen” when her own physician did not attempt to do an exam.

The opposition was united in their argument that sitting down and listening to the patient builds more trust than performing a daily physical exam. Dr. Kaminski similarly pointed out that doctors can establish a true partnership with the patient by sitting down and having a meaningful conversation. Dr. Shah took this one step further in noting that performing a “full but cursory exam can come across as just checking boxes,” which may be off-putting to our patients and erode their trust.

It was clear that Team Waste-of-Time did not support a wholesale elimination of the physical exam, but rather advocated for the exam to be used in a focused and purposeful manner. Dr. Shapiro offered another strategy to making the patient a partner in the doctor-patient relationship: ask the patient specifically if there is anything they would like the doctor to take a closer look at. He also encouraged narration, in which the doctor voices whatever they are doing or seeing during the exam. This serves to include the patient as a partner in the exam, reassure them, and let them know what their doctor is thinking. Dr. Barrett similarly noted that narration of the exam builds trust by dampening the power dynamic and encouraging the doctor to use patient-centric language, free of medical jargon.

A more practical argument from this side of the debate was the harmful effects of waking patients early in the morning for a routine exam. Dr. Rosenberg noted that it can be dehumanizing and make a patient feel like a specimen to have a doctor wake them and remove their gown for a physical exam in the early morning. Dr. Aleman pointed out that we also interrupt prayer times, meal times, and time with family by doing unnecessary exams.

Perhaps the most succinct summary of the night came from Dr. Schultz saying, “If not done with a particular purpose, [the exam] can feel like mindless box-checking for documentation/billing purposes… Done well, it can strengthen the human connection between clinician and patient.”

Did you miss this #JHMChat? Don’t worry! Be on the lookout for information on our next chat.

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2 Comments

  1. Mohammed Elhassan November 28, 2021 at 2:13 pm - Reply

    I had many patients alluding to me that they like the fact they are being checked, and many others complaining that their doctors “did not even touch me.” I totally agree that physical exam can build relationships with patients, and I also strongly agree that “routine” daily exam can be unnecessary or even disturbing to patients when done in the wrong time and style. Patient might wonder why their physician check their belly every day when they are being investigated for ischemic check pain and they do not have “belly symptoms.” Also, physicians should know how much useful the exam maneuvers they routinely practice are in detecting and excluding disease by referring to evidence and guidelines. Kernig and Brudzinski’s signs, for example, can be uncomfortable to patients and their sensitivity and specificity are not the greatest anyways.

  2. Sumuka Fertility Center January 26, 2022 at 10:31 am - Reply

    Communication between the doctor and patient is very important and doing exam to patient is also like drug. The treatment should start from this only. Good information given here.

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About the Author: Lanna Felde, MD

Lanna Felde, MD, is an Assistant Professor in the Division of Hospital Medicine at UT Southwestern Medical Center. Dr. Felde earned her medical degree and a concurrent master’s degree in public health at UT Health Science Center at San Antonio. She completed her residency in internal medicine at UT Southwestern and joined their faculty in 2018. Dr. Felde is the Director of UTSW’s Hospital Medicine Elective for Internal Medicine Residents and Chair of the Communications Committee for the Division of Hospital Medicine. Her interests include hospital best practices, social determinants of health, and medical education utilizing digital media.

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