An old-timer bemoans the demise of the physical exam, or hyposkillia:

We need teachers who truly comprehend the value of a good medical history, the rewards of a pertinent physical examination, the power of knowing how to think, and the importance of accountability; teachers who first use the stethoscope, not an echocardiogram, to detect valvular heart disease; teachers who first use the ophthalmoscope, not magnetic resonance imaging, to detect intracranial hypertension; teachers who first use their eyes, not a blood gas apparatus, to detect cyanosis; teachers who first use their hands, not computed tomography, to detect splenomegaly; and teachers who always use their brains and their hearts, not a horde of consultants, to manage their patients.

We need teachers who don’t order expensive, state-of-the-art studies when cheaper, conventional tests supply the same information; teachers who don’t administer a slew of medications in an effort to alleviate every possible ill; teachers who appreciate that doing nothing is, at times, doing a lot; and teachers who realize that many patients get well despite what we do, not because of what we do.

Those days are long over, my friend. Readers of this blog know why this is happening: time pressures in a fee-for-service reimbursement system and defensive, objective-based medicine.

I recently discussed this with someone who is completely unapologetic about the demise of old-school, physical exam-based medicine: “I compare it to this – why travel by horse and buggy when you have a car available? The same goes for today’s medicine.” (via Notes from Dr. RW)

Update:
retired doc comments.

Update 2:
Dr. RW addresses some of the comments here.

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