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Physical examinations create a tangible connection

Excerpted from the In Practice blog on boston.com.

I remember my first visit home at the end of my second year of medical school. I’d just received my black doctor’s bag loaded with medical equipment. Like a 16-year-old with a new driver’s license, begging to do the very errands she’ll soon groan about, I went around my parents’ living room and took everyone’s blood pressure, looked in their ears and throats — and then made my “rounds” again.

While I never got tired of doing physical exams, they did, of course, lose some of that initial thrill.

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But now that parts of the exam are being outsourced to other caregivers, I miss them. And I find myself feeling not so different than I did on that spring day so long ago when I asked, “Can I take your blood pressure, please?”

Nurse practitioners and physicians’ assistants do annual physicals, hospital admissions, and preoperative medical clearances. Medical assistants take blood pressures and perform other tasks previously done routinely by physicians.

There are good reasons for a team approach, including current and projected physician shortages, especially in primary care, and pressures on physicians to crowd many patients onto their schedules because of low Medicare and other reimbursements. Many argue, reasonably, that some jobs must be offloaded to give doctors more time to be doctors — to diagnose patients’ problems, formulate treatment plans, and offer counseling about how to prevent illness.

But I sometimes worry that we could be losing something important.

For example, measuring blood pressure offers an opportunity to touch a patient, one I’m not sure we doctors should be so quick to abandon. Many times I have seen a patient for a consultation — say, to discuss birth control or assisted living or an imminent divorce — and capped the visit by taking the patient’s blood pressure and listening to their heart and lungs.

In over 20 years in practice I have never yet had a patient ask me why I was examining them when their problem wasn’t “physical.” Touching a patient is part of paying attention to them, of caring for them.

The physical exam has another, harder to define but no less important benefit: It makes me feel more connected and attuned to the patient.

Recently, my practice adopted the common procedure of having a medical assistant take the patient’s blood pressure after escorting him or her into an exam room.

But I keep forgetting about the new procedure, and start my exam by taking the patient’s blood pressure.

Last week, as I wrapped the cuff around her arm, a patient said: “Oh, someone already did that.”

I said, “I know, but somehow I can’t stop taking blood pressures myself.”

The patient, a thoughtful young woman, asked, “So it’s like a ritual for you? Like breathing before yoga?”

And I answered, “Exactly!”

Dr. Suzanne Koven is a primary care internist at Massachusetts General Hospital. Read more from her blog at boston
.com/lifestyle/health/blog/inpractice.
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