The See-Through Doctor: Sitting Naked in the Exam Room

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There once was a time, only dimly remembered today, when doctors still hesitated to ask a patient to disrobe, struggling instead to drop the mouth of a stethoscope down a slightly unbuttoned shirtfront.

While this may sound like history from the horse-and-buggy era, it was commonplace in this country just 50 years ago.[1] Yet in that relatively short time, patient and physician roles have metaphorically begun to reverse. Today, it is the patients who are demanding that reluctant doctors stand naked in the exam room. “Your test results have just come back from Dr. Google,” they begin accusingly, “and I think we should discuss those patient satisfaction scores.”

That, at least, is the nightmare. The reality is more nuanced. Huffing, puffing, and horror stories won't change the fact that transparency and accountability are here to stay, and this is a good thing. A metal stethoscope on a bare chest may feel uncomfortable, but it is a small price to pay for clinically critical information.

Unfortunately, the Internet often resembles a kaleidoscope more than a stethoscope. Some physician information will be evidence-based, including focused measures of clinical quality and standardized surveys of the patient experience. Other information, such as online comments on bedside manner, will feel more like wild subjectivity than the wisdom of crowds.

Doctors, accustomed to shrugging off studies of inappropriate practice variation, will complain loudly about inappropriate practice evaluation variation. Patients, of course, will respond, “But my doctors are different.”

The “see-through doctor” may feel exposed, but needed privacy, including protected peer review, will not disappear. Still, we are in the early stages of who shows what to whom, when, and why. So, doctor, if it gets a little uncomfortable sitting on that exam table, don't worry. We understand.

That's my opinion. I'm Michael Millenson, President of Health Quality Advisors and the Mervin Shalowitz, MD, Visiting Scholar at Northwestern University's Kellogg School of Management.