The worth of human touch

"What is a physical examination worth?" Paul Hyman, MD reflects on his answers in his perspective piece, The Disappearance of the Primary Care Physical Examination—Losing Touch.[1] 

As our primary care practice has pivoted to telehealth and the physical examination has been ripped away from me, I find myself reflecting on what value the examination has. It is clearly needed at times to make a diagnosis. But I now realize the other ways I use the examination to advance care and its significance to my own well-being. It is a means through which I pause and physically connect with patients, I demonstrate my knowledge and authority, and is a tool I use to persuade patients and reevaluate their narratives.

Performing P.E. helps him as a physician, not just his patients.

The examination, though, is more than a tool that informs diagnosis and treatment. I now realize its value to me. The quiet moments when I am listening to a patient’s heartbeat and breath can be centering, similar to the part of a meditation where one refocuses on one’s own breathing. Abraham Verghese has commented extensively on the role of the physical examination as ritual and its importance to patients; he also has observed how this ritual brings physicians satisfaction through human connection. Only now have I come to recognize the examination as a ritual that is restorative and brings me calmness and confidence.

This resonates with me.

In an admission of my own insecurity, the physical examination remains one of the few domains where I maintain a sense of professional skill and authority. I have never been much of a proceduralist. The mainstay of what I offer to patients is the ability to listen to them, to use critical thinking skills, and to offer my knowledge and experience. But those skills are sometimes challenged in a world where patients research their own health and develop their own medical narratives. The physical examination remains a place where I offer something of distinct value that is appreciated.

But, as I wrote in a perspective piece, these are still good days to heal. 

Online interactions cannot completely replace actual human interaction between the physician and the patient, but through these remote meetings, we can able to offer communication bridges. With telemedicine, these are still good days to be a doctor. But I still wish for better days ahead when the pandemic is over, when I can talk to my patients face to face, hold their hands, and celebrate our shared humanity.

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[1]Hyman P. The Disappearance of the Primary Care Physical Examination—Losing Touch. JAMA Intern Med. Published online August 24, 2020. doi:10.1001/jamainternmed.2020.3546