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

  • Physician grief and patient loss: Navigating the emotional toll of medicine

    Francisco M. Torres, MD
  • Is primary care becoming a triage station?

    J. Leonard Lichtenfeld, MD
  • Violence against physicians and the role of empathy

    Dr. R.N. Supreeth
  • Finding meaning in medicine through the lens of Scarlet Begonias

    Arthur Lazarus, MD, MBA
  • Profit vs. patients in the U.S. health care system

    Banu Symington, MD
  • Why medicine needs military-style leadership and reconnaissance

    Ronald L. Lindsay, MD
  • Most Popular

  • Past Week

    • Psychiatrists are physicians: a key distinction

      Farid Sabet-Sharghi, MD | Physician
    • The loss of community pharmacy expertise

      Muhammad Abdullah Khan | Conditions
    • Is primary care becoming a triage station?

      J. Leonard Lichtenfeld, MD | Physician
    • Sibling advice for surviving the medical school marathon [PODCAST]

      The Podcast by KevinMD | Podcast
    • What is a loving organization?

      Apurv Gupta, MD, MPH & Kim Downey, PT & Michael Mantell, PhD | Conditions
    • What is vulnerability in leadership?

      Paul B. Hofmann, DrPH, MPH | Conditions
  • Past 6 Months

    • Direct primary care in low-income markets

      Dana Y. Lujan, MBA | Policy
    • Psychiatrists are physicians: a key distinction

      Farid Sabet-Sharghi, MD | Physician
    • Patient modesty in health care matters

      Misty Roberts | Conditions
    • The U.S. gastroenterologist shortage explained

      Brian Hudes, MD | Physician
    • The Silicon Valley primary care doctor shortage

      George F. Smith, MD | Physician
    • California’s opioid policy hypocrisy

      Kayvan Haddadan, MD | Conditions
  • Recent Posts

    • Leadership buy-in is the key to preventing burnout [PODCAST]

      The Podcast by KevinMD | Podcast
    • A daughter’s reflection on life, death, and pancreatic cancer

      Debbie Moore-Black, RN | Conditions
    • What to do if your lab results are borderline

      Monzur Morshed, MD and Kaysan Morshed | Conditions
    • Direct primary care limitations for complex patients

      Zoe M. Crawford, LCSW | Conditions
    • Understanding the unseen role of back-to-school diagnostics [PODCAST]

      The Podcast by KevinMD | Podcast
    • Public violence as a health system failure and mental health signal

      Gerald Kuo | 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

    • Psychiatrists are physicians: a key distinction

      Farid Sabet-Sharghi, MD | Physician
    • The loss of community pharmacy expertise

      Muhammad Abdullah Khan | Conditions
    • Is primary care becoming a triage station?

      J. Leonard Lichtenfeld, MD | Physician
    • Sibling advice for surviving the medical school marathon [PODCAST]

      The Podcast by KevinMD | Podcast
    • What is a loving organization?

      Apurv Gupta, MD, MPH & Kim Downey, PT & Michael Mantell, PhD | Conditions
    • What is vulnerability in leadership?

      Paul B. Hofmann, DrPH, MPH | Conditions
  • Past 6 Months

    • Direct primary care in low-income markets

      Dana Y. Lujan, MBA | Policy
    • Psychiatrists are physicians: a key distinction

      Farid Sabet-Sharghi, MD | Physician
    • Patient modesty in health care matters

      Misty Roberts | Conditions
    • The U.S. gastroenterologist shortage explained

      Brian Hudes, MD | Physician
    • The Silicon Valley primary care doctor shortage

      George F. Smith, MD | Physician
    • California’s opioid policy hypocrisy

      Kayvan Haddadan, MD | Conditions
  • Recent Posts

    • Leadership buy-in is the key to preventing burnout [PODCAST]

      The Podcast by KevinMD | Podcast
    • A daughter’s reflection on life, death, and pancreatic cancer

      Debbie Moore-Black, RN | Conditions
    • What to do if your lab results are borderline

      Monzur Morshed, MD and Kaysan Morshed | Conditions
    • Direct primary care limitations for complex patients

      Zoe M. Crawford, LCSW | Conditions
    • Understanding the unseen role of back-to-school diagnostics [PODCAST]

      The Podcast by KevinMD | Podcast
    • Public violence as a health system failure and mental health signal

      Gerald Kuo | 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...