Have doctors lost our physical exam skills?

Does your doctor really know how to use a stethoscope or palpate your abdomen?

Today’s physicians do not have the physical exam skills that our predecessors did.  We can argue if this has diminished medical quality. I’m not sure that it has.  But it has completely changed how medicine today is practiced.  The reason for declining physical exam skills is that technology has to a significant extent supplanted physicians’ hands, eyes and ears.  In the olden days, the stethoscope was the diagnostic tool for examining hearts.  Ask your doctor when was the last time he or she percussed the abdomen.  I spent a month as a medical student with a legendary cardiologist who could make all kinds of cardiac diagnoses right at the bedside using 2 advanced medical instruments known as ears.  Surgeons and gastroenterologists in years past had to make  diagnoses of acute appendicitis and other abdominal emergencies based on feel and their ‘gut’.  Neurologists made accurate diagnoses of stroke just using their clinical skills.

An Advanced Medical Instrument

These days, there is really no need to be a sleuth with a stethoscope since any murmur or extra click heard by a human will be followed by an echocardiogram.  I can’t recall a case of appendicitis in my career that didn’t involve a CAT scan to confirm a surgeon’s suspicion.   And, if a stroke is suspected, a head CAT scan will be arranged.

Since, medical technology has in many cases taken over the physical examination, doctors’ hands-on skills have decayed.  There is much less pressure for our exam skills to be superb since we know that some rescue scan or diagnostic test that does it better will follow.  Conversely, if a physician were seeing a patient with stomach pain, and there was no technology available, I surmise that this doctor would do a more careful exam than he otherwise would.  Get my point?

Are patients better served with more accurate technology to make and exclude diagnoses?  Some are and many aren’t.  We all celebrate how technology in medicine has revolutionized the profession and has saved and improved lives.  I rely upon this every day in my practice.  But we must acknowledge that this progress has exacted many costs.  Poorly or hastily chosen diagnostic tests can lead patients down false pathways.  A CAT scan is not a physician.  It does not understand the nuances of the patient’s situation.  It cannot place the the scan’s finding in context of a living breathing human being. It’s data to be considered by the medical professional along with many other clinical factors.  What if the scan, for example, suggests Crohn's disease but the sentient physician knows this is not the case. 

Will there be a  role for medical professionals once artificial intelligence becomes embedded in the medical landscape?  Will AI replace physicians’ cognitive skills just as our physical examination skills have decayed?  Is this just fanciful science fiction?  Here's my own response to these inquiries.  Would you have believed 10 years ago that cars and trucks would be driving themselves?  What seems impossible today may become reality tomorrow.