Many are bemoaning the deterioration of physical exam skills that the current generation of doctors are displaying.

Bob Wachter says it may not be that big a deal. “Even if we could create a new generation of expert physical examiners,” he writes, “would it be worth the time and trouble?” He doubts it, saying the time spent to learn and perform a comprehensive physical has to be “weighed against cold-hearted considerations of accuracy, reliability, inter-observer consistency, and the cost of time.”

Technology has the potential of making parts of the physical exam obsolete. Traditionalists may be arguing for staying with a horse and buggy when cars are rapidly becoming available.

Dr. Wachter instead suggests more time be spent on “timeless” patient communication skills, like “eliciting the history, describing prognosis, discussing alternative treatments, determining the patient’s attitudes about end of life care, and apologizing for medical errors.”

In addition to technology, a whole host of other incentives are shifting emphasis away from the physical exam, not least of which are malpractice fears (where an objective study would pull more weight in a trial than a subjective physical exam finding), and the financial pressure to maximize the quality of services (which devalues the time spent doing a physical exam).