BOOKS BY HANS DUVEFELT, MD
Top 25 Doctor Blogs Award
Read my VERY FIRST blog post:
Recent posts
- Quick and Easy: How to Save Primary Care
- All These Gut Feelings: A 10-Year Old With Belly Pain
- Don’t Eat More of Anything (Until You Decide What to Eat Less Of)
- Why Can You Have Angina With Normal Coronary Arteries? For the Same Reason You Can Have Heart Failure With Preserved Ejection Fraction
- Another Gut Feeling: A Case of Visceral Hyperalgesia?
- Big Leg, Little Leg: The Lymphedema That Came and Went (Comments invited)
- Health Care Through the Back Door: The Dangers of Nurse Visits
- Since When? Looking for Change: The Heart of the Art of Diagnosis
- A Very Near Miss: The Worst Bout of Sciatica Ever
- Notes From My Sick Bed: Cold War, Viruses and History Repeating Itself
- How to Talk to Clinicians: Forget Workflows, Just Tell Us How Things Work
- Hijacked for Public Health Purposes: Previsit Planning and Morning Huddles
- A Stubborn Rash: When Doctors Don’t Communicate
- A Country Doctor Practices Bibliotherapy: Books by Prescription
- Always Looking for Zebras
- The App That Helps Me Be a More Patient Centered Physician
- The Misunderstood Medicinal Use of Yogurt
- I Heard About Chilblains in British Television Shows, Not in Medical School
- Care Reminders? No Time to Think on the Clinic Assembly Line
- A Year of Extremes: From Medieval Masks to mRNA Vaccines; From Science Denying Flat Earthers to the Prospect of Civil War
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”.