When I was a medical student, I was fascinated by the skill of older physicians to make a diagnosis and describe a complicated pathology just using the physical exam skills. For centuries the main three components of the physical exam including auscultation (listening via stethoscope) palpation (feeling with hands) and percussion (eliciting sounds by tapping) were used to make a diagnosis.
It takes years of practice and experience to perfect that skill.

The recent explosion of medical and information technology has changed the ways we make a diagnosis. The issue has become not how to get enough information but how to interpret the abundant data available via multiple tests and studies.

As the technology evolves, so is the way we interact with the patient. Portable ultrasound allows us to “look inside” the patient right there at the bedside, making an instant diagnosis of an effusion or evaluating cardiac contractility in real time. The patients are well aware about the medical technology available and often request a specific test before the physician even had a chance to examine the patient.

It has been a few years since I talked to a cardiologist about heart sounds and murmurs. We discuss the results of a cardiac ECHO and cardiac catheterization. Those tests provide us with far more diagnostic information than a plain auscultation.

The future looks even brighter. Genomic testing will allow us to look inside the “original code” of our bodies, making a diagnosis before the disease process has even started.

So, is there a role for a physical exam in contemporary and future medicine?

There is no doubt that we will have to change our ways of practicing medicine. It is unlikely, though, that those tried and true skills will go away completely.

Many patients still feel that the interaction with a physician is not complete until the doctor laid his hands on the patient. In many cases, it is a “make the patient feel good” approach. Yet, we know that in medicine the perception could be the reality and the psychological component to many diseases is difficult to underestimate.

Despite the rapid availability of very reliable and informative tests like XRs, CT scans and MRIs, nothing beats your stethoscope or your hands when the situation is truly urgent. It is “poor form”, for example, to make a diagnosis of a tension pneumothorax by a chest XR. In an even less dramatic circumstance, detecting new wheezing or rales on a lung exam or a new murmur on a cardiac auscultation will have a significant diagnostic value.

Sometimes, you do physical exam simply because you have to. In some cases you are not going to learn anything new by dropping a stethoscope on the chest of the ICU patient who has been there 2 months or more. Yet, it is a necessary “ritual” to be able to write a billable note for Medicare. Not doing it and documenting it for the purpose of billing is a fraud.

In conclusion, the face of medicine will change as the technology evolves. It is unlikely, though, that the basic physical exam is going to be completely eliminated as a diagnostic tool.