BOOKS BY HANS DUVEFELT, MD
Top 25 Doctor Blogs Award
Read my VERY FIRST blog post:
Recent posts
- Set It and Forget It: My Successful First Use of Ambulatory Blood Pressure Monitoring
- Patient: “Another Doctor Said Keto Was Bad For Diabetics” – Me: “Let Me Tell You the Story of the Flex Fuel Man”
- Funny Examples of Swedish Medical Terminology
- “Fruit is God’s Candy”
- The Art of Diagnosis: Go With Your Gut, Dig Deeper, Step Back or Start Over
- When I Escalated His GERD Treatment, My Patient Got Worse. Now I Know Why
- “This Doesn’t Usually Hurt that Much”: Patients With Fibromyalgia Spectrum Disorder
- Another Birthday Reflection
- Fatigue, Tinnitus, Dizziness and Dyspnea. What’s the Diagnosis?
- Can the Practice of Primary Care Medicine ever be Practical Again?
- I Actually Love Technology
- Habits for Health and Happiness
- The Gift of Time
- The Art and Soul of Medicine Exist in the Ordinary
- The Science of Clinical Intuition
- To Understand What You Already Know
- There is a Word for People Like Me: AMBIVERT (A Personal Reflection)
- The Call to Be a Primary Care Doctor
- The Annual Physical: Is it Worth Having?
- My Blog is Setting Many Records, Except One, a Surprise Hit from 2015
Left out the value of your implication that patient age is vital in evaluating the usefulness of the physical exam and the importance of doing the Review Of Systems before the physical or at least some of both simultaneously.
At least my patients bragged the had a “real physical” and were reassured by my having done so.
Perfect. Well said and it’s time for all FPs to subscribe to this view
Every time I try to comment via the site it asks for a website. I add mine and it gets stuck.
Larry
I don’t know what it looks like from the reader’ perspective. Very few people seem to have trouble making comments, not sure what’s going on.
I agree that the return on investment for a hands on exam is limited — BUT like most experienced docs I can recall multiple life saving discoveries on the exam. Review of family hx as well as personal hx is important as we move to a better understanding of genomics in medicine.
I find it very concerning that young doctors are taught not to examine patients — they think they can provide care with a fully clothed patient – never look at their skin/ listen to hearts etc. Doubt they would even know what they are looking at if a patient wants them to actually examine them.
Old school – perhaps – depends on whether you want to practice EXCELLENT medicine or just get by with the bare minimums that the guidelines suggest.
Gary, you said it beautifully. AND you have to practice to know what you are seeing and hearing and smelling and feeling. If not, you have no confidence in your findings or lack thereof, and neither will your patients. YOU will HAVE to ask the radiologist to do your job for you. Do you really NEED to X-ray a hand to diagnose arthritis that is staring you in the face? YOU can hear a pneumonia if you listen carefully and practiced 3 days before it may show up on the X-ray. YOU can feel strange nodules in breasts, thyroids, prostates, lymph nodes, skin. livers, ovaries, uteri. YOU can feel pulsating abdominal aortic aneurysms. Swollen gallbladders. Rectal polyps. Testicular cancers. Hemorrhoids. Varicocoels. Varicose veins are easy to see if pants are off and patient is standing! So are melanoma, basal cell and squamous cell carcinoma. YOU might even be a REAL doctor.
already left one. guess I need to log in first, but that does not show up until after I have written.
John, your 8:37 comment shows and I liked it.
Great. Was not sure we had connected until now. John Dykers.com
and you can feel tender trigger points in patients with Myofascial Pain Syndrome that have never been accurately diagnosed. You can feel a tender SacroIlliac joint.
I remember finding a tennis ball size colon cancer, a pneumonia, a tick, a nodular melanoma…. all during annual exam without patient complaints. Then I had one wanting a physical because unexplained fatigue; she had diffuse inspiratory and expiratory wheezes but insisted she had “no chest symptoms”.