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Letters to the editor

In favor of physicals

I was absolutely delighted to read Ruthann Richter’s article “The Healing Hand” in the summer edition of Stanford Medicine. It addressed an issue that has concerned me, a retired physician, for several years now: the apparent reluctance of young physicians to do a thorough physical examination. As medical students, my classmates and I were thoroughly trained in the art of the physical examination at the old school at Clay and Webster Streets in San Francisco, and I have always been convinced of its importance.

I have a personal anecdote relating to this current lack of utilization of a physical examination. Not long ago, my adult daughter informed me that she had visited a new internist in the city where she lives. That physician did not touch her body in any way, not even with a stethoscope, but rather ordered a huge battery of laboratory tests in lieu of any physical examination. Needless to say, I advised my daughter to seek the care of a “real” physician!

So I say three cheers to you for your article, with the hope that the renewed emphasis on the physical examination will continue to grow. There is no substitute for the physical examination.

Kenneth Dunn, MD
Stanford medical school class of 1958

 

I was shocked. Shocked and horrified by “The Healing Hand.”

In 1955, when I was a med school sophomore at Stanford hospital in San Francisco, we were taught all those things routinely. And grilled on them. And made to demonstrate them.

At my annual physical this year, my internist ordered $800 of “routine tests” and never laid a hand on me. Or in me.

Of course the people who own clinical labs and sell CT and MRI scanners are delighted to radiate me instead of examine me. Medicine has gone expensively backward in 50 years.

Thomas Lowry, MD
Stanford medical school class of 1957

 

I very much enjoyed your article “The Healing Hand.” As a practicing diagnostic radiologist, I have seen firsthand the explosion of imaging and understand the concern that the physical examination is being partially supplanted by CT and other diagnostic tools.  

However, I’m surprised your article cited the CT examination for abdominal pain/appendicitis as being in the category. No doubt there are plenty of negative and possibly unnecessary CT scans being ordered. However, the increased use of CT scan for suspected appendicitis has resulted in a marked reduction in the negative appendectomy rate (the percentage of time a normal appendix is found at surgery when the physical exam was positive — i.e., the false positive rate has plummeted). That means fewer people are getting unnecessary surgeries, fewer surgical and anesthesia complications, etc.

Before radiology gets too much of a black eye, let’s remember that a lot of good has come from imaging. From time to time, we even hit a home run, as above. I’m sure the middle ground is best — using physical examination to better triage patients for the judicious use of imaging.

Hiren Patel, MD
Stanford medical school class of 1997

Letters are edited for clarity and length

 

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