“When we shortcut the physical exam, when we lean towards ordering tests instead of talking to and examining the patient, we not only overlook simple diagnoses that can be diagnosed at a treatable, early stage, but we’re losing much more than that … we’re losing a ritual that I believe is transformative, transcendent, and is at the heart of the patient-physician relationship … I’d like to introduce you to the most important innovation in medicine … and that is the power of the human hand — to touch, to comfort, to diagnose and to bring about treatment” – Abraham Verghese, MD (From “A Doctor’s Touch” TED Talk)
In his TED Talk entitled, “A Doctor’s Touch,” Dr. Abraham Verghese discusses the importance and value of the physical examination, which has been diminished and almost lost in modern-day medicine. Many physicians and other health care workers skimp on the physical exam (involving actually touching the patient) due to lack of time and/or over-reliance on modern technology and imaging tests to diagnose patients. He argues that in modern times, the power of the human hand in medicine is often overlooked, but it has the potential to transform and strengthen the patient-physician relationship.
One of the many reasons I am so thankful to be in the field of physical therapy is that we are provided the unique opportunity to see patients for an entire hour, without disruption, at the initial evaluation. This means we not only can get a detailed and thorough subjective history and discussion of what goals are important to the patient, but we also have ample time to perform a thorough physical exam, including hands-on assessment of the client. This hands on assessment may include, but is not limited to, palpation of trigger points in muscles, general assessment of tissue tightness and mobility, skin inspection and palpation to assess for color or temperature changes, assessing the end feel of muscles and joints to figure out what might be causing limited range of motion, manual testing of muscle strength, assessing pulses when relevant, testing of the patient’s skin sensation, palpation for areas of localized and referred pain, palpating to assess for structural abnormalities or concerns, and much more.
While physical examination is not infallible, it often leads to a quick and accurate diagnosis, or at least recognition, of an abnormality, such as a nodule or painful palpation. Although modern imaging tests allow for a much more precise observation of the area, they are expensive, and may reveal “abnormal findings” that may not actually be clinically significant or relevant. Current research shows that the way MRIs are used is not only expensive, but often leads to a poor diagnosis and improper treatment. Abnormal findings on an MRI are not always the source of the patient’s problem or pain. This is where a skilled practitioner needs to correlate the MRI findings with the patient’s symptoms through the use of a thorough physical exam.
In addition to being used as a diagnostic tool, physical touch in a physical exam, when conducted thoroughly and attentively, has the power to establish a deeper sense of trust and cooperation between the patient and the healthcare worker. Patients value the human touch and attentiveness of a physical examination, as it conveys a sense of caring and allows for a deeper understanding of the patient’s condition and needs.
At Elite Muscle Recovery, we want our patients to experience a thorough physical exam and feel that they can trust and rely on their Doctor of Physical Therapy. In addition to a full hour of one on one assessment at the initial evaluation, we also structure our schedules to allow that every follow up session is a full hour of one on one treatment time as well. This allows for continued trust-building and thoroughness in assessing a patient’s response to treatment through physical touch.
Please call our office today to experience the power of physical touch in a physical therapy evaluation and subsequent treatment sessions. We would love to work with you and help you feel more understood and cared for in your quest to get rid of your pain.
Kind regards,
Dr. Katelyn Renard, DPT, PT, OCS