The Physical Exam Begins with a Handshake

The physical examination is a potent antidote. Taking time and effort with the patient to understand their condition through the close art of observation is therapeutic for the clinician’s soul. Feeling a patient’s joints time after time and knowing they are no longer as swollen or tender is an extremely satisfying experience. Knowing patients better by understanding the stories of their tattoos personalizes an experience that our faceless healthcare sector simply does not prioritize because it cannot be turned into a metric.

In short, although clinicians believe they are examining patients, a strange process is simultaneously occurring on the other side: Patients are examining their clinicians.¹³ Patients are listening to their clinicians, listening to their hearts and asking whether they can be trusted. Patients are feeling the warm touch of a clinician’s fingertips lingering over their interphalangeal joints. On a deep level, patients are assessing whether their clinicians are sincerely conducting the physical exam or merely performing them.

The physical exam is something that has been both praised and condemned, often in the same breath. It’s been lauded as a mythical panacea to the many ails of our healthcare system and, as a result, been seen as a letdown when it doesn’t meet those expectations. As I rheuminate on the physical exam, I see it as something else. I see the physical exam as the core, the very pith, of clinical rheumatology, upon which all our other efforts rest.

The physical exam is, ultimately, what both clinicians and patients make it out to be. If we imbue it with meaning, purpose and sincerity, then we can use it as a tool to ensure the world of rheumatology is more humanistic and remains true to its goal of maintaining the healing touch.

Bharat Kumar, MD, MME, FACP, FAAAAI, RhMSUS, is the director of the rheumatology fellowship training program at the University of Iowa, Iowa City, and the physician editor of The Rheumatologist. Follow him on X @BharatKumarMD.

References

1. Oaklander M. The Coronavirus killed the handshake and the hug. What will replace them? Time. 2020 May 27. https://time.com/5842469/corona-virus-handshake-social-touch.
2. Heatley Tejada A, Dunbar RIM, Montero M. Physical contact and loneliness: Being touched reduces perceptions of loneliness. Adapt Human Behav Physiol. 2020;6(3):292–306.
3. Bjorbækmo WS, Mengshoel AM. ‘A touch of physiotherapy’—the significance and meaning of touch in the practice of physiotherapy. Physiother Theory Pract. 2016;32(1):10–19.
4. Eckstein M, Mamaev I, Ditzen B, Sailer U. Calming effects of touch in human, animal, and robotic interaction—scientific state-of-the-art and technical advances. Front Psychiatry. 2020 Nov 4;11:555058.
5. Leder D, Krucoff MW. The touch that heals: The uses and meanings of touch in the clinical encounter. J Altern Complement Med. 2008 Apr;14(3):321–327.
6. Hashim MM, Edgeworth DM, Saunders JA, Harmon DC. Patient’s perceptions of physical examination in the setting of chronic pain. Ir J Med Sci. 2021 Feb;190(1):313–316.
7. Sackett DL. The rational clinical examination. A primer on the precision and accuracy of the clinical examination. JAMA. 1992 May 20;267(19):2638–2644.
8. Kazmi Z. Effects of exam room EHR use on doctor-patient communication: A systematic literature review. Inform Prim Care. 2013;21(1):30–39.
9. Elder AT, McManus IC, Patrick A, et al. The value of the physical examination in clinical practice: An international survey. Clin Med (Lond). 2017 Dec;17(6):490–498.
10. Silverman B, Balk M. Digital stethoscope-improved auscultation at the bedside. Am J Cardiol. 2019 Mar 15;123(6):984–985.
11. Jackson SS, Le HM, Kerkhof DL, Corrado GD. Point-of-care ultrasound, the new musculoskeletal physical examination. Curr Sports Med Rep. 2021 Feb 1;20(2):109–112.
12. Lee PS, Koo S, Panter S. The value of physical examination in the era of telemedicine. J R Coll Physicians Edinb. 2021 Mar;51(1):85–90.
13. Rose G, Segesten K. Someone who cares—patients’ experiences concerning health examinations. Scand J Caring Sci. 1995;9(2):105–112.