Health Column: Have doctors lost their touch?
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
A few months ago, I experienced a remarkable patient encounter. I saw for the first time, a bright, engaging 85-year-old lady, who resides in an assisted living facility. I spent 45 minutes obtaining her current complaints, past medical history, family history, medications and allergies, social situation, habits, and how she liked to spend her time. I examined her sore ankle and summarized my thoughts about her care. I felt that I had been quite thorough, but the patient frowned and remarked, “Is that all you are going to do?” I had missed the ball. What I shortly learned was I had not met her expectations. I had not listened to her heart or lungs, nor felt her belly. “How would you know, doctor, if I am healthy, if you don’t examine me carefully?”
Early on in medicine, I learned three important rules:
Always sit down in a patient’s presence (the patient will over-estimate how long you spent with her).
Listen to the patient (he will often tell you his diagnosis).
Touch the patient!
Touching is a humanizing ritual. It is a longstanding element of this very special relationship physicians and patients share. Most of us find comfort in being touched by our doctor. Why did I not meet this patient’s needs?
There is an increasing body of evidence doing physical exams on healthy individuals is a huge waste of time. The scientist in me knows if I hear an abnormal wheeze in a patient with no lung symptoms, it is most likely a false positive finding. The wheeze means nothing, but may lead me down a clinical cascade of useless tests. Second, some claim technology (CT scan, MRI) often renders the physical exam obsolete. Finally, physicians sometimes cross the boundaries of appropriately touching patients. Medical malpractice companies warn their insured physicians about the legal dangers of touching patients.
Three great excuses — three rationalizations for not doing what I had long ago learned to do. I ignored the knowledge many patients expect to be touched. Touching is comforting, even healing for some patients. Sometimes the art and heart of the physician must trump the scientific evidence.
GJ Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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