Ever wonder about the utility of the annual physical examination, or any physical exam at all? I have, if for no other reason than I have suffered, by my accounting, through over 60 000 of them, and I find them to be of rather low yield for the time spent. Sure, the strep throat or appendicitis or recognizable rash can be low-hanging diagnostic fruit, and negative exams often lead me down the right path when choosing ancillary studies. But these exams are for acute complaints in the ER—I’ve also performed thousands of annual exams, or with kids, biannual or triannual exams, while staffing the Big Sur Health Center, in rural central California. I can probably count on existing digits the number of times I picked up actual significant findings that made a difference in outcomes.
Anyway, I bring this up as I am currently teaching the physical exam course to first-year medical students on a practice patient once a week, and I am amazed by what they are instructed to do in our politically correct health care environment. Seriously, here is the supplied script:
(Knock knock.)
“May I come in? Hi—I’m Joe Curzall, first-year medical student, and I would like to take a history and perform an examination. It that OK with you? Anything I can do to make you comfortable? Is the temperature OK? The lighting? Is English OK or do we need an interpreter? Do you need a chaperone? Do you have a religious preference that would affect our examination? What gender do you identify with?” (Love the look on the face of the 80-year-old female practice patient.)
And further into the history and review of systems of the man married for 40 years: “Are you sexually active? With how many partners? Women, men, or both?” And on. And on. For 30 minutes before the first hand is laid on the patient’s body.
What in God’s name has happened to us? And is saying “God’s name” in an editorial allowed? Will I get a bad editor satisfaction survey? Will I get in trouble with Joe Pizzorno? Will I get sued for theological/journalistic improprieties? You catch my drift.
But as long as we do actually live in such a ridiculous world, I found myself pondering what would happen if I followed these same protocols in my ER histories, specifically at 3:00 AM on a Saturday night shift.
(Knock knock.)
“May I come in? Hi—I’m Dr Benda, emergency physician, and I would like to take a history and perform an examination. Is that OK with you?”
“Huh? Are you F*@k$#% kidding me?”
“No, of course not. Anything I can do to make you comfortable?”
“Yeah. A shot of Dilaudid in my butt and a script for some Percs.”
“Soon enough. Do you need a chaperone?”
“Um, sure. That cute triage nurse would be just fine.”
“What gender do you identify with?”
“I don’t know. What’s today?”
“Are you sexually active? With how many partners? Women, men, or both?”
“Yes. Yes. Yes. Now where is that Dilaudid?”
You get the picture. What we teach, what is considered essential information, has followed the PC path into absurdity, along with HIPPA, and sexual harassment policies, and patient satisfaction surveys. I’ll tell you a secret: My own fantasy is to be reincarnated as Doc Adams from the old Gunsmoke radio series. No charts, no drugs, no insurance, no administrators. Basically, “Where are you shot? Hmmm—take a swig or two of this and I’ll try to dig it out.”
Ah, well, perchance to dream. In the meantime, back to the metrics and quality assurance spreadsheets. And physical exams …
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