The physician physical examination-is it almost extinct?

 The physical examination (PE) was for many years a routine fixture of a person's annual checkup. It seem it is much less so now.

Three of my physician friends who recently retired went in search of a new primary care physician because their PCP also retired.All three found someone but all were somewhat nonplussed when their initial encounter with their new PCP did not involve a physical exam. They were each weighed, and their blood  pressure checked by a physician assistant. One also took part in some elements of the Medicare Annual Wellness Visit (AWV) though he did not know what a AWV was. He was somewhat proud of his artistic skill in drawing a clock face depicting the time ten fifteen .All three admitted they "needed" a PCP mainly to order lab tests and write prescriptions. All of these recently retired physicians were internists and spent a total of 170 years practicing and doing physical exams, so an annual or initial physician visit without a physical exam was hard for them to get their heads around it.In each instance the new physician was a board-certified internist. So what things might account for a sea change in the way internists do business.

Dr. Abraham Verghese is ID internist at Standford and is erudite,articulate advocate of the physical exam and his U tube performances are a joy to watch.Verghese characterizes the PE as an important ritual of considerable value to both the patient and the physician.He emphasizes that the PE is a ritual and rituals have been of great value to humans for many hundreds of years. I am afraid that Dr. Veghese efforts as admirable as they are will have little to no effect because the payment arrangement that internists now face leave little time for physical exams.

Focused physical exams will continue to be done  by ER docs and surgeons and neurologists.

Verghese shows two slides one of the  "old time" ward rounds in which the students and the professor were around the patient and another slide with a group of physicians sitting around a table each with a laptop making " I rounds" . Verghese claims ownership of the term:" I patient". which is the depiction of a patient on the electronic health record (EHR) who only has fleeting resemblance to the actual patient.

In the world of the I patient as he exists in the Electronic health record  the patient often has had a complete physical exam multiple times and a through system review .However,the real life patient remembers no such exams as they were never done but just copied and pasted into the chart  from an idealized template.If a physician signs off on a physical exam that was not done, it that considered fraud.Does that act not pose a risk in any subsequent litigation? Why do physicians practicing in hospitals or large clinic settings allow the phantom exams to be part of the permanent medical record?