Saturday, February 11, 2006

Annual "physical exam" as "touchstone for contextualized care"

The Feb. 13,2006 issue of the Archives of Internal Medicine published a letter to the editor which I will reference here to echo the thoughts expressed.

Dr. Christine A. Sinsky writes that she structures her practice around the annual examination. Regarding it she says:

"I structure my entire practice around the annual examination. It is when I address prevention, coach patients on healthy life-styles, and do the annual review of each chronic medical condition. Invariably, patients bring new symptoms for evaluation as well. It is a complex visit, focused on integrated, longitudinal care."

That is also, to a large degree, what I did. Replacing the annual exam with a series of admonitions of what to be screened for is to reduce the patient to an abstraction of eligibilities for various organizations's recommendations for screening rather personally dealing than the individual human being they are with their set of unique feelings,worries, concerns, and questions about their own health and what they should or should not do in regard to some perceived or real health issue.

Of course, one can deconstruct the examination and conclude such things as "listening to the heart is not cost effective" but placing the stethoscope to a person's chest is a "chance to touch" the patient and has value above and beyond the occasional discovery of a significant murmur. It is part of touching and hopefully connecting with a patient.

Her letter was in response to a recent editorial in the Archives that suggested that both patients and physicians support and value the annual examination. Some of the criticism of the annual exam may be from its name. The way Dr. Sinsky ( and I) performed it, it was much more than a exam, the mechanics of which took up a fairly small part of the time for the visit. Most of the time spent was talking.First, on whatever the patient wanted and secondly about what I wanted to impart to the patient regarding her current issue or whatever screening or preventive issues were pertinent to her particular situation. It is a time for assessment of issues, for giving advice, for expressing interest and concern about the patient, it is much more than what happens on a boy scout camp physical.





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