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I would heartily endorse Rose Brettell’s1 and Crispin Fisher’s2 view that careful physical examination of patients should be paramount and particularly in the isolated setting of the GP’s consulting room far away from pathology labs and ‘hi-tech’ investigative machines.
But I feel one reason has not been sufficiently emphasised. Patients expect to be examined, respect it, and are reassured by it. When the doctor lays his hands on the areas of the body whose symptoms suggest are diseased the doctor builds a tactile bridge to the patient with which no amount of talking can equate. My grandson, following years of suffering severe childhood eczema, travelled over 200 miles to see a consultant dermatologist who never even looked at his skin!
I have friends with chronic back pain who have never had their backs examined! Keith Hodgkin, a distinguished GP guru of the sixties and seventies, maintained that, ‘Once you’ve done a rectal examination the patient will tell you everything!’
Perhaps two kinds of doctors are emerging: the ‘hi-tech’ doctor in the hospital who uses machines to diagnose and the GP in their consulting room who uses their five senses plus a few simple instruments to achieve the same end — and incidentally much more quickly and certainly less expensively.
- © British Journal of General Practice 2017