Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A connection is lost when we outsource the physical exam

Suzanne Koven, MD
Physician
August 27, 2012
Share
Tweet
Share

I remember my first visit home at the end of my second year of medical school. I’d just received my black doctor’s bag loaded with medical equipment. Like a 16-year-old with a new driver’s license, begging to do the very errands she’ll soon groan about, I went around my parents’ living room and took everyone’s blood pressure, looked in their ears and throats — and then made my “rounds” again.

While I never got tired of doing physical exams, they did, of course, lose some of that initial thrill.

But now that parts of the exam are being outsourced to other caregivers, I miss them. And I find myself feeling not so different than I did on that spring day so long ago when I asked, “Can I take your blood pressure, please?”

Nurse practitioners and physicians’ assistants do annual physicals, hospital admissions, and preoperative medical clearances. Medical assistants take blood pressures and perform other tasks previously done routinely by physicians.

There are good reasons for a team approach, including current and projected physician shortages, especially in primary care, and pressures on physicians to crowd many patients onto their schedules because of low Medicare and other reimbursements. Many argue, reasonably, that some jobs must be offloaded to give doctors more time to be doctors — to diagnose patients’ problems, formulate treatment plans, and offer counseling about how to prevent illness.

But I sometimes worry that we could be losing something important.

For example, measuring blood pressure offers an opportunity to touch a patient, one I’m not sure we doctors should be so quick to abandon. Many times I have seen a patient for a consultation — say, to discuss birth control or assisted living or an imminent divorce — and capped the visit by taking the patient’s blood pressure and listening to their heart and lungs.

In over 20 years in practice I have never yet had a patient ask me why I was examining them when their problem wasn’t “physical.” Touching a patient is part of paying attention to them, of caring for them.

The physical exam has another, harder to define but no less important benefit: It makes me feel more connected and attuned to the patient.

Recently, my practice adopted the common procedure of having a medical assistant take the patient’s blood pressure after escorting him or her into an exam room.

But I keep forgetting about the new procedure, and start my exam by taking the patient’s blood pressure.

Last week, as I wrapped the cuff around her arm, a patient said: “Oh, someone already did that.”

I said, “I know, but somehow I can’t stop taking blood pressures myself.”

ADVERTISEMENT

The patient, a thoughtful young woman, asked, “So it’s like a ritual for you? Like breathing before yoga?”

And I answered, “Exactly!”

Suzanne Koven is an internal medicine physician who blogs at In Practice at Boston.com, where this article originally appeared. She is the author of Say Hello To A Better Body: Weight Loss and Fitness For Women Over 50. 

Prev

When politicians decide a woman's fate

August 27, 2012 Kevin 6
…
Next

I cherish the relationships I’m able to build with my patients

August 27, 2012 Kevin 2
…

Tagged as: Cardiology, Primary Care

Post navigation

< Previous Post
When politicians decide a woman's fate
Next Post >
I cherish the relationships I’m able to build with my patients

ADVERTISEMENT

More by Suzanne Koven, MD

  • A hospital leader speaks out against the transgender military ban

    Suzanne Koven, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Don’t hesitate to talk to your doctor about work

    Suzanne Koven, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Patients should silence their phones in the exam room

    Suzanne Koven, MD

More in Physician

  • Why midlife men feel unanchored and exhausted

    Kenneth Ro, MD
  • How medicine reflects women’s silence

    Priya Panneerselvam, DO
  • Language doulas bridge care gaps

    Deepak Gupta, MD, Kaya Chakrabortty, and Yara Ismaeil
  • The myth of no frivolous medical lawsuits

    Howard Smith, MD
  • Divorced during residency: a story of clarity

    Emma Fenske, DO
  • A husband’s story of end-of-life care at home

    Ron Louie, MD
  • Most Popular

  • Past Week

    • The Silicon Valley primary care doctor shortage

      George F. Smith, MD | Physician
    • The ethical conflict of the Charlie Gard case

      Timothy Lesaca, MD | Conditions
    • Preserving your sense of self as a doctor

      Camille C. Imbo, MD | Physician
    • Understanding the hidden weight bias that harms patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The ethics of mandatory Tay-Sachs testing

      Sheryl J. Nicholson | Conditions
    • The geometry of communication in medicine

      Patrick Hudson, MD | Physician
  • Past 6 Months

    • Why you should get your Lp(a) tested

      Monzur Morshed, MD and Kaysan Morshed | Conditions
    • Rebuilding the backbone of health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Direct primary care in low-income markets

      Dana Y. Lujan, MBA | Policy
    • The dismantling of public health infrastructure

      Ronald L. Lindsay, MD | Physician
    • The flaw in the ACA’s physician ownership ban

      Luis Tumialán, MD | Policy
    • Stop doing peer reviews for free

      Vijay Rajput, MD | Education
  • Recent Posts

    • Why modern dentists must train like pilots [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why you need a GLP-1 exit plan

      Holli Bradish-Lane | Conditions
    • Why midlife men feel unanchored and exhausted

      Kenneth Ro, MD | Physician
    • How medicine reflects women’s silence

      Priya Panneerselvam, DO | Physician
    • Why not all ADHD generics are created equal

      Ronald L. Lindsay, MD | Conditions
    • Early Alzheimer’s blood test: Is it useful?

      M. Bennet Broner, PhD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The Silicon Valley primary care doctor shortage

      George F. Smith, MD | Physician
    • The ethical conflict of the Charlie Gard case

      Timothy Lesaca, MD | Conditions
    • Preserving your sense of self as a doctor

      Camille C. Imbo, MD | Physician
    • Understanding the hidden weight bias that harms patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The ethics of mandatory Tay-Sachs testing

      Sheryl J. Nicholson | Conditions
    • The geometry of communication in medicine

      Patrick Hudson, MD | Physician
  • Past 6 Months

    • Why you should get your Lp(a) tested

      Monzur Morshed, MD and Kaysan Morshed | Conditions
    • Rebuilding the backbone of health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Direct primary care in low-income markets

      Dana Y. Lujan, MBA | Policy
    • The dismantling of public health infrastructure

      Ronald L. Lindsay, MD | Physician
    • The flaw in the ACA’s physician ownership ban

      Luis Tumialán, MD | Policy
    • Stop doing peer reviews for free

      Vijay Rajput, MD | Education
  • Recent Posts

    • Why modern dentists must train like pilots [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why you need a GLP-1 exit plan

      Holli Bradish-Lane | Conditions
    • Why midlife men feel unanchored and exhausted

      Kenneth Ro, MD | Physician
    • How medicine reflects women’s silence

      Priya Panneerselvam, DO | Physician
    • Why not all ADHD generics are created equal

      Ronald L. Lindsay, MD | Conditions
    • Early Alzheimer’s blood test: Is it useful?

      M. Bennet Broner, PhD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

A connection is lost when we outsource the physical exam
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...