By Dr. Conway McLean,

FAPHWc, DABFAS

ESCANABA — Remember some of the old doctor shows, there have been quite a few over the years. The patient would lie down on the exam table and the physician would place their hands on the individual’s belly to palpate their “insides,” amounting to feeling around. Of course, this was always followed with use of a stethoscope to listen to their breathing and heartbeat. At last, voila! The wise healer would provide the precise diagnosis.

How did he do it? What magic spell was he weaving with “the laying on of hands?” Our TV doctor was practicing the art, and science, of physical diagnosis. This is a technique developed over the last few centuries, whereby a healthcare professional is able to determine vital medical information, merely through the process of listening with a stethoscope, careful observation, feeling, and also tapping, technically referred to as percussion.

This technique, the physical exam, when properly performed, while armed with detailed knowledge of wellness and sickness, may allow the healthcare provider to identify a great variety of medical conditions. All based on the physical signs and symptoms obtained by the knowledgeable physician, using only a stethoscope, his hands, his ears, and his mind.

This requires no complex or expensive technology, there is nothing to be ordered or sent to a lab, in the act of gathering information about a patient’s health through a “routine” physical examination. But many residents of this country cannot recall the last time a true physical exam was done. Is it out of fashion? No longer the flavor of the times? And the answer is a cautious ‘Yes.’

No matter the specialty, there has been an obvious trend in modern medicine: the physical exam is rarely performed. We have come to rely on tests and studies, providing as they occasionally do a definitive answer. This has been beneficial in a court of law and not always the clinic. America has a far higher rate of malpractice suits than any other country in the world. Because of the litigious nature here, many healthcare providers practice defensive medicine, ruling things out with various tests and studies, JUST TO BE CERTAIN. A physical exam doesn’t provide the kind of hard data that holds up in court.

Even specialties considered extremely “physical,” like physiatry (the field of physical medicine), orthopedics, as well as podiatry, no longer stress the physical exam in school or clinical rotations. If the problem can’t be tested by some form of technology, then it doesn’t exist. But there is none that can evaluate the quality of motion of a diseased joint. No machine which can appreciate the subtle coloration in the early stages of a developing infection in the foot of a diabetic.

Will AI replace healthcare providers? Who can say, but many experts would answer affirmatively. If allowed to advance (itself?!), why wouldn’t artificial intelligence be able to perform most of these tasks, especially those performed currently by some machine or technician. A majority of the tests ordered by healthcare providers are now primarily automated, performed only secondarily by an assistant applying the device or placing the patient.

In the 1950s, a study presented to the AMA revealed a high failure rate by doctors in the recognition of important heart sounds. This landmark study started a trend which has only picked up speed. Medicine became more scientific, requiring statistical analyses. A physical examination provides the physician with abundant, vital information, but leaves no defined number or valuation of his exam. Providing a precise description of physical exam findings has not proven sufficient in the realm of modern medicine.

Part of this trend away from a hands-on approach has been the development of new and better technologies. These allow doctors to examine structures inside the body never before available. Still, they can’t give the whole picture, they can’t feel a tender abdomen, test carefully a healing sprain. Too much information is to be gleaned from the physical exam for it to be ignored.

Admittedly, a physical exam isn’t necessary for every problem or by every specialist. It may be difficult for the layperson to know definitively if a hands-on exam should be performed. Certainly, some tests are ordered early on, x-rays being a common example, since they give us information about these deeper structures. Regardless, for most problems, a hands-on exam should begin the investigative process of evaluation for any medical condition.

This is a complex discussion: there are multiple factors involved in making a medical diagnosis. But let us not lose sight of the fact that the human mind has a great ability to intuit, to imagine, to contemplate, to make important associations and connections. Perhaps artificial intelligence will eliminate the need for these very human abilities, relieving us eventually of all responsibility, all the varied mundane tasks we perform (remember Wall-E?). Until then, until AI comes to save the day, nothing will replace the human touch.

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Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with offices in Escanaba, Marquette, and L’Anse. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. His articles on health and wellness appear in multiple local and national publications. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.