Touchpoint

Abstract

Visual Abstract.

“It’s my leg,” he said, shifting uncomfortably in his hospital bed. “It just won’t stop throbbing.”

My brother-in-law had been hospitalized several days earlier with a new diagnosis of ulcerative colitis. His symptoms had been severe—abdominal pain, hematochezia, and profound fatigue. The workup was extensive: labs, CT, colonoscopy. Just as a treatment plan was solidifying, this new pain emerged.

I came only as family. But medicine is hard to leave at the door.

I pulled back the blanket. A firm, tender cord snaked along the outside of his thigh—warm beneath my fingertips. It felt like superficial thrombophlebitis.

Yet his team had dismissed it as muscular. No one had examined the leg.

And so, the odyssey began.

First came an orthopedic consult. Then X-rays. An MRI. A neurology consult. Days passed. Finally, an ultrasound confirmed the thrombosed superficial vein and ruled out DVT. But it didn’t stop there. Hematology. Vascular surgery. A flood of labs.

I saw it in his face: confusion slipping into frustration. Trust quietly fading. All for a condition that often resolves with warm compresses and NSAIDs.

By discharge, his chart was bloated with notes, tests, consults. His stay prolonged. His final bill—well, that was an entirely different kind of pain.

This wasn’t just a family member’s hospitalization. It became a moment of reckoning for me as a physician and teacher.

I kept thinking: what are we modeling for our trainees? That the physical examination is optional? That a diagnosis begins with imaging, not observation? That consulting more means knowing more?

I teach at the bedside. Or at least I try to. And that week, I watched a cascade of missed opportunities. The leg went unexamined. The history half-heard. The diagnosis delayed, not for lack of information, but for lack of touch.

And I wondered: Are our residents seeing this too? Are they learning to order before they observe? To refer before they reason?

The consequences are more than inefficiency. They’re educational. Ethical. Human. Each unnecessary test, each extra day, carries risk. False positives. Procedural harms. Financial strain. Eroded trust.

But perhaps most harmful is what it teaches: that our senses are unreliable, that our hands are less useful than our orders, that the screen is the primary site of care. I’ve felt that temptation myself. The reflex to click before thinking. The security blanket of data. But this experience reminded me why we must resist.

We cannot teach what we do not value. If we want trainees to examine, to listen, to trust their instincts, we need to show them how. We need to pause, put our hands on the patient, and invite them to join us.

That leg—tender, swollen, warm—taught me more than any textbook ever could. And I carry it with me, not just as a clinical memory, but as a teaching one.

Next time I round with residents, I won’t just ask, “What did the ultrasound show?” I’ll ask, “What did it feel like under your hands?”

Because the bedside is not behind us. It is right there, waiting.

And it’s time we return to it.