I adored the physical exam in medical school. We were taught the exam by sections, and I devoured one after another. No matter how much I had learned about physiology, it was during our physical exam sessions that I finally started to feel like I was learning how to be a doctor. We were getting the tools we needed to really take care of patients. We would have the means to collect our medical data and see the pathophysiology come to life.
Sometime in residency, physical exams lost their magic. I wouldn’t say it was on any particular day. It became part of the routine. As an intern, I would be seeing the same patients for several days in a row in the early morning hours. We both came to expect it: the same questions, the same exam, and my regular quick retreat to get my data to my team. When I started to feel the pressure of seeing patients as quickly as I could, I started to view physical exams as a checkbox on my list of things to do before going on to the next patient. Hundreds of patients later, it became a reflex.
Then I had the luck (or misfortune) of treating my soon-to-be brother-in-law in the emergency department. I had just grabbed his legs and then abdomen mid-sentence when I noticed his weird looks and nervous remarks. In the years we had known each other, never had a situation presented itself for me to need to look for edema. Nor had we ever had a conversation during which I would grab for his gut. No wonder he thought this was strange. We weren’t strictly defined by just the doctor-patient relationship as I am with so many of my patients. He was my patient, yes, but also someone who knew me as more than just his doctor.
While this may have been acceptable behavior for years as a training physician, it suddenly occurred to be that in any other social setting, it really wasn’t. When I walk down the street, I don’t want a stranger suddenly grabbing a part of my body. Even among friends, that could be seen as a strange behavior. What made it so different now? Yes, I may be a physician, but everyone still has a right to their own sense of personal space, especially my patients.
Though I will be eternally grateful to my former patients I’ve had for giving me the opportunity to care for them, I realize just how much trust they put in me to let me into their personal space. And now is the time for me to live up to the trust by respecting the personal space of each of my patients, either by asking if I can do a physical exam or just letting them know that I will be starting one. The physical exam has become another privilege that I have as a physician to bond with my patients. It should be treated as one.
Marissa Camilon is an emergency medicine resident. This article
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