BOOKS BY HANS DUVEFELT, MD
Top 25 Doctor Blogs Award
Read my VERY FIRST blog post:
Recent posts
- Delivering Health Care is Like Practicing a Religion
- Make it So
- Your Doctor Remembers Most Things About Medicine, But Not Everything About You
- Five Plain Truths About Gout
- I Do Fewer Elective Procedures Now Than When I Started Out. This is Why:
- A Renaissance For Phrenology? (A Country Doctor Reads 8/24/22)
- Replay: A DOCTOR’S PARTING WORDS
- Don’t Be Insulted If I Prescribe Narcan Along With Your Pain Medication
- The Intrusive, Insensitive Nature of Primary Care
- Untitled
- Understanding a CBC (Complete Blood Count)
- Abnormal Lab Tests: Not Always a Sign of Disease
- Dosing Warfarin: From Flowsheet to Workflow. Is This Progress?
- A Country Doctor Reads: Consider the Vagus Nerve, No Matter What Seems to be the Diagnosis | The Wall Street Journal
- A Country Doctor Reads: The Solution Shop and the Production Line — The Case for a Frameshift for Physician Practices | NEJM
- Changing EMR Again: Goodbye Greenway, Hello Epic
- The Useless, Almost Drive-Through, Nearly Touchless, Free But Expensive and Wasteful Physical Exam
- Somebody Stole My Inhaler Idea. Finally!
- There Are Too Many Back Seat Drivers in Medicine Today
- Quick and Easy: How to Save Primary Care
A Country Doctor Writes: 
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”.