iPatients and the demise of the bedside physical exam

Stanford’s Abraham Verghese has a wonderful perspective piece in the current NEJM.

With the advent of electronic information systems in hospitals, today’s medical residents spend more time in front of computer monitors instead of talking to patients.

Dr. Verghese coins the term the “iPatient,” where “emergency room personnel have already scanned, tested, and diagnosed, so that interns meet a fully formed iPatient long before seeing the real patient. The iPatient’s blood counts and emanations are tracked and trended like a Dow Jones Index, and pop-up flags remind caregivers to feed or bleed.”

That would be funny if it wasn’t so true.

Without corroborating data with physical findings, this often leads to imprecise observations. Whether this can lead to unnecessary testing is unknown, although “in a health care system in which our menu has no prices, we can order filet mignon at every meal.”

Hospitals are increasing patient turnover rate, and there’s more pressure than ever for teams to reduce the length of hospital stay. This means faster discharges, and an incentive to expediently order more tests rather than spending the time to see and talk to patients.

The result will be a generation of physicians who place no importance in the physical exam, and a scenario where “bedside skills have deteriorated as the available technology has evolved.”

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