A pointless exam can be just as bad as a stupid MRI

Dr. Abraham Verghese, says the Times, is reviving the lost art of the physical exam. He cuts quite a figure on the wards, with his white coat, his stories, and his diagnostic maneuvers, reminding us of "the doctor who missed nothing and could swiftly diagnose a peculiar walk, sluggish thyroid or leaky heart valve using just keen eyes, practiced hands and a stethoscope."

Here's where the definitions of art and science matter, though. The margin here is too narrow to contain a detailed discussion of where these two bugbears embrace and where they face off, fangs bared.

The applicable stab of a definition in this case, I think, is this: in a science, we try and apply a community's rigorous professional definition to our individual classifications. In art, we try and apply our own individual classifications a priori. Yes, rigorous professional definitions are important to art as well, but less so.

Verghese's approach to the physical exam falls short whether it's seen as an art or a science, and flirts with nostalgia as its sole justification. If it's art, then why should Verghese pick out the 25 maneuvers he and his Stanford colleagues choose to the exclusion of all others? And, if it's science, why does Verghese seem to ignore the incomplete but abdundant literature on the evidence-based physical examination?

The worst thing about the Times article is the way it conflates evidence-based medicine with ignorance of the physical exam. A pointless physical exam can be just as bad as a stupid MRI. I suspect that Verghese can make a stronger case for the physical exam than "this is the way the giants of old practiced medicine," but I have yet to see it.

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