The laying on of hands

I had my physical this week. It was interesting being a patient after having been an attending physician for the past 2 months. A few things surprised me:

(1) My doctor asking me about my family history caught me off guard—so much so that I forgot to tell him some important details. I ask my patients this question all the time.

(2) My doctor wore a tie, which I appreciated. Interesting, as I know about the studies showing that they carry lots of germs.

(3)  It meant a lot to me that my doctor did a thorough physical examination.

I don’t examine my patients during every visit. Sometimes its because it doesn’t seem necessary. Usually it’s because of time: medication refills, referrals, multiple medical complaints, status of chronic medical conditions, they take up a large portion of the visit. But I know the exam matters to patients because they have told me so. Patients here have complained to me about other doctors who skipped this part of the encounter. When I was training on the East Coast no one seemed to care about whether you did a good physical exam. The complaint was why didn't the doctor send me for an x-ray, CT, or MRI. I'm still not sure why the expectations in this area seem so different. I can tell you another reason why we doctors don't examine patients more often. When we're staring at labs that tell us that the patient’s diabetes is uncontrolled, or we see that their blood pressure is dangerously high, it feels like what the patient needs is education/reinforcement/motivational interviewing, not an exam. But having been a patient recently, I’m starting to believe that thoughtful examination of a patient can add a lot to the encounter: clues, information, trust. So maybe its time we started making it more of a priority.

Sitka from a floatplane
Mountains to the East, Pacific to the West. The airport is at 3 o'clock.
The bridge that connects it to Sitka is the John O'Connell Bridge.