Between 8% and 15% of Western populations are left handed. The difficulties they face in a society constructed for right handers are unrecognised by the majority. Even our language reflects the discrimination against the left handed.The French word gauche for left has come to mean clumsy or awkward, and the Latin sinistrum has developed evil connotations. Contrast this with the words adroit and dextrous, which, derived from their French and Latin equivalents for right, now mean clever or skilful. The origins of these words have more to do with the historical mistreatment of the left hander—for example, forcing left handed schoolchildren to write with their right hand, than any defect inherent in such people.
From the beginning medical students are instructed to use their right hand
The medical world has been guilty of propagating this discrimination. Clinical teaching dictates that all examinations should start from the right hand side of the bed. This position clearly favours the right hander. From the beginning medical students are instructed to use their right hand regardless of hand preference. This teaching is reinforced by the many textbooks of clinical examination on the market.
Is there a problem? Currently, there is no objective evidence, as no surveys have looked at handedness of undergraduates and their experiences throughout their clinical years. There is no doubt that some left handed doctors have excelled themselves in the medical field. In wider society left handers have overcome difficulties to become notable artists, sportsmen, musicians, etc. Yet these talented few can blind us to the problems that more ordinary people face. It is claimed that left handers suffer more accidents, have increased rates of delinquency, and die younger than right handers, although these claims have been challenged.
So why has no one complained? Probably because indoctrination begins on the first day of the clinical course. If they experience any initial difficulties left handers are likely to be told that there is no alternative to using their non-dominant hand for examination. Medical students will be too intimidated to protest or will accept this without question so early in their clinical careers.
How many medical students are affected by this? There were 11 807 entrants to United Kingdom medical schools in 1998. If we assume that between 8% and 15% of these are left handed then there could be as many as 944 to 1771 medical students forced to use their non-dominant hand for clinical examinations every year.
Some doctors may remain sceptical. Those right handers who have difficulty empathising should try palpating abdominal organs with their left hand, or recall the difficulties they had (or still may have) examining the left eye during fundoscopy. When faced with a lack of access to the right hand side of the bed would these doctors move the patient or even the bed?
But why should doctors examine from the right hand side of the bed? The only reason is tradition. We have been examining this way for decades. Yet there is no reason why a high standard of clinical examination cannot be performed from the left hand side of the bed, using the left hand. It would require very little effort to adapt our present approach to examination for the left hander. Most of the examination would simply be a mirror image of conventional techniques. The radial artery can be assessed by the left hand, the jugular venous pulse with the left eye dominant, the tendon reflexes elicited with the left hand, etc. Some modification would be required for the asymmetrical organs, such as the heart, liver, or spleen.
For this to be possible, the profession has to acknowledge that a problem exists. The royal colleges would need to take the lead in promoting this enhanced style of clinical practice. Clinical teachers and examiners of all levels would need the mental dexterity (or should that be mental sinisterity?) to assess students opting to use their left hands. Such a revolution in clinical practice would be liberating for left handers. They need not waste time attempting to learn how to assimilate information from their non-dominant side. Instead they can focus on the ever increasing demands of the medical curriculum.
For decades our methods of clinical examination have gone unchallenged and remain rooted in tradition. The emphasis of examination from the right side of a patient has the potential to cause difficulties for the left hander. This rigid adherence to historical practice echoes the efforts of misguided school teachers, who forced their left handed pupils to scribe with their right hands. This practice has been abolished by schools, yet we perpetuate it in the medical world. If change was desired it would be a simple matter to modify clinical techniques to allow examination from the left. This enlightened approach would be enabling to the left handed doctor. The left hander already faces many difficulties in our right handed society. Is it not time that we adopted a more flexible approach to clinical examination?