Physicians Should Always Perform a Physical Examination

      To the Editor:
      Your editorial in The American Journal of Medicine of July 2017
      • Alpert J.S.
      Will physicians stop performing physical examinations?.
      was impressive and is very true. I would like to add that we “the physician community” carry the responsibility not only in developed countries, but we must be equally competent and ready to perform our duties in any part of the world. Think of Sub-Saharan Africa or poorly developed nations in Asia. When you don't have all the luxuries and gadgets of medicine, how will you diagnose and treat?—“history and physical examination.”
      Recently, I saw a patient with tuberous sclerosis complex. The first step for the diagnosis was to look at the patient's face and her skin lesions. Another example of examination was when I examined the nails of a patient with recurrent bilateral pleural effusion. With all the advanced tools, he was treated for congestive heart failure with bilateral effusions until I examined his nails and diagnosed him with yellow nail syndrome.
      We definitely use the advanced tools of medicine to confirm or reject our impressions after the examination, but the physical examination determines the directions of our investigations. The lack of physical examinations is driving the cost of medicine excessively high because we overdo the tests on every patient. Emergency department physicians will not allow any patient with sinus headache to go home without a computed tomography head scan.
      My suggestion is to rotate our medical students and residents in those areas of world where there is no facility to do the tests, and the only thing you can do is to take a history, perform a physical examination, and treat. The physical examination will always be the first step in making the diagnosis. When you see the patient and shake hands with him or her, the physical examination begins right there.


        • Alpert J.S.
        Will physicians stop performing physical examinations?.
        Am J Med. 2017; 130: 759-760