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doctor can relate a surprising finding when examining a patient that led to a new diagnosis. Personally, one that stands out in my career, was an elderly lady who had been to urgent care, her primary physician, and an emergency room for constipation. She had been given handouts and instructions on how to get her bowels moving on each occasion. When she came to me, I in- sisted on a full examination including a pelvic exam! The result was a finding of a grapefruit size ovarian tumor blocking the colon and causing constipation. No one else had examined her! Thankfully, it was a benign tumor and her constipation was re- ceived with surgery. This is only one of many examples I could site in 40 plus years of Internal Medicine practice.


I would argue that physical contact with a patient enhances the relationship. It builds trust and when therapeutic instructions are given, the patient is more likely to follow them. Sometimes an exam reveals a less severe condition than either thought over the phone. For instance, a cough or sore throat that may have been overrated on the phone can be more clearly defined in person. A normal exam and normal oxygen saturation can reassure the patient and perhaps avoid unnecessary antibiotics. A rash is often less ominous in person than on text message.


The physical examination could be considered a ritual that brings satisfaction to the patient and the physician through human in- teraction. The act of listening actively to the patient and then listening to their breath and heart beat is calming and relaxing to the patient. I think it also brings calmness and confidence to the doctor. The doctor-patient relationship can be a powerful tool in medicine, particularly when facing life threatening situations. That relationship, in my view, can only be strengthened by re- peated emotional and physical contact.


In today’s world where the patient has access to so much medi- cal information online, I think the physical contact and confi- dence in your physician to help you sort through the potential diagnoses, already formulated via the internet, is essential.


While I can see the benefit of keeping patients safe-at-a-distance during the throes of a pandemic, I believe in physical diagnosis and building a physician-patient relationship with accurate and appropriate testing. I know this has been my time-tested approach and while it will no doubt change with the use of telemedicine, I will continue to believe that the physical examination has value. With the use of the computerized medical record and group practice where you may see multiple practitioners and extenders, the need for this type of physical examination, rather than relying on what someone else "thought" is important to avoid a misdiagnosis.


I am also quite aware that this human physical contact is needed for my own well being!


John Benedum MD, Board Certified Internal Medicine. Cur- rently Medical Director, Personal Health Management and Executive Health Services at Atrium Healthcare in Charlotte, NC. 704.512.3800


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