Thursday, October 22, 2009

Curse roentgen!

I have been a medical student for the past four years. I didn't know that its better to use the bell of the stethoscope to record blood pressure, that its better to do the entire cardiac examination with the patient's head inclined 30 degrees, that spasticity increases with the speed of the passive movement and the list is endless. All this I found in an age old book, and old journals on medical examination. There's so much a doctor can infer from physical examination.There are lot of new clinical tests a doctor can invent, new signs that are yet to be unraveled. But all he does is listen to the symptoms and scribble a few investigations and treat the patient based on that. The satisfaction you derive by diagnosing something based on clinical examination is indescribable. I diagnosed Broca's aphasia in a patient yesterday. May that will appear trivial to a neurologist. But I jumped up and down for fifteen minutes. You know why I had to be so excited?. Its because I never heard any doctor say "he has a cortical infarct, because he has broca's aphasia" but I have often heard them say "On the CT image, the infarct also seems to involve his cortex , the broca's area, so that explains his slurring of speech". Can you think such a doctor can practice without investigations??. I hate roentgen for his invention. True, investigations today are a boon. The fact that people don't question the relevancy of doing investigations without a complete physical examination is tragic. This strengthens my desire to become a teacher of medicine, 'not professor'. I like teaching not 'professorizing'. So if you go to a doctor next time, demand a complete physical examination. A complete physical examination will take at least 15 minutes for a trivial complaint, provided you aren't malingering. You have the right to demand the relevancy of an investigation. And don't be carried away by 'house'. You can see the whole team investigating all the time!! and yeah, they don't do enough examination. I still love 'house. m.d' for its satire.


  1. I feel the same. When a doctor cannot rely on her/his very hands, ears and brain, its ridiculous how s/he takes the help of a machine that runs on electricity to reveal the pathology. I support your views on patients demanding for a detailed physical examination before being slapped with an order for an expensive investigation. Basic findings and provisional diagnosis should always be made after a meticulous physical examination, and investigation/s can be called for, only to make a crucial decisions on the treatment plan. Clinical examination has no substitutes.