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My doctor doesn’t bother to examine me physically Add to ...

The Question

My doctor is very rarely “hands on.” He usually just sits there with his laptop, asking questions and typing. I had a bronchial infection, sore throat and severe nasal congestion, and he didn’t check my nose or throat; he just had his assistant check my blood pressure. I find something wrong with that. Is there? Should I say something? I’m no shrinking violet if it comes to that, but if I’m wrong call me out.

The Answer

In this case, the only person who needs calling out is the doctor. While every physician has a style, it sounds as if yours is taking a shortcut. If he keeps skipping the physical exam, he could miss something. At the very least, it is eroding your confidence in his abilities to confirm his diagnosis, and that in itself is harmful.

Doctors only want to touch patients when necessary. If you have osteoarthritis and are seeing your physician for a prescription refill, you probably do not need to be examined every single time – only occasionally – for the same ailment if your symptoms haven’t changed. Your case, however, is much different.

Though your illnesses may most likely have been from a viral infection, a doctor should still want to rule out strep throat, an acute bacterial sinus infection, and pneumonia. Your family physician is not going to be able to figure that out sitting six feet away tapping on his laptop.

Your doctor probably skips the physical exam occasionally, thinking that it won’t provide any new information. Or it may be that he’s been in a particular rush the times you’ve seen him. The reason doesn’t matter. The point is that as a patient, you are rightly concerned about a doctor who repeatedly skips the physical exam.

Batya Grundland, family physician at Women’s College Hospital, thought it was “a little unusual” for the doctor not to do a physical exam with your symptoms, because for that situation she would teach medical students to do so.

“If someone comes in saying ‘I’ve been coughing and wheezing and have a sore throat,’ we would do an exam,” said Dr. Grundland. “Usually before I examine a patient, I have a pretty good idea of whether it’s strep or not. But I want to make sure I’m not missing something. It’s pretty standard, especially in the case of an infection, to be followed up by a physical exam.”

If a physical examination is missed enough times it can lead to medical error, and that is why I recommend you raise the issue with your family doctor. You do not want to be on the other end of a missed diagnosis.

“We’re all trying to maximize patient safety; it’s really great when our patients say something,” said Dr. Grundland. “Physicians are human, and most are doing their best, but being human they will make mistakes and take an inappropriate shortcut.”

Dr. Grundland suggests you either make a special appointment to raise the issue or bring it up at the next visit. You could say: “I have a question. I notice you don’t very frequently do a physical exam after we talk. Why is that?”

That should get the conversation rolling and your doctor examining.



The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com.

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