The Lost Art of Bedside Medicine

Is the physical exam dead? 

Clinical observation has been part of medicine for thousands of years, ever since Babylonian, Chinese and Indian physicians first examined bodies. Lately, however, the practice has become a rarity as technology has enhanced physicians’ ability to see and hear things that were previously hidden. 

But that doesn’t mean bedside medicine should be put to sleep. 

The value of the bedside exam

While advancements in medical technology have improved doctors’ ability to diagnose and treat certain illnesses, they have their limitations. 

CT scans and X-rays can’t feel where an abdomen is tender. They can’t perceive pained facial expressions when a particular area of a patient’s body is touched. And they can’t ask questions about a patient’s diet, physical activities and lifestyle. 

These factors can often only be examined and evaluated by a physician who understands and values bedside medicine. In fact, an effective bedside exam actually allows physicians to make better use of technology. Doctors who are skilled at bedside exams are often able to gather more and better information about their patients’ conditions, allowing for more selective use of medical technology. 

Unfortunately, the financial realities of the healthcare industry have pushed bedside medicine to the wayside. 

From the bedside to conference tables

The end of bedside medicine as a common practice can almost certainly be linked to the push for greater efficiency. 

There used to be an expectation–from patients as well as insurance companies–that doctors would spend quality time with their patients. It was, after all, the way medicine had been practiced for centuries. Physicians were trusted to take the time necessary to get to know their patients and make the best possible decisions. 

Then the bottom line got in the way. 

Insurance companies called for greater efficiency. Physicians were pressured to keep exams brief, see more patients and shorten hospital stays–all in the name of decreasing costs and increasing revenues. 

Hospitals, too, played a role in moving doctors away from the bedside and into the conference room. After all, it’s much more efficient for physicians to meet and discuss patient care and make treatment decisions around a conference table than it is to have them doing it during rounds. 

Reviving bedside medicine

There is no question that the dizzying array of high-tech, sophisticated and expensive tools and tests has put bedside medicine on the ropes and some patients have suffered as a result. 

A simple search of the Internet reveals many documented cases of patients whose conditions went untreated for long periods of time because doctors were led down the wrong diagnostic road due to their reliance on technology. 

These cases, along with calls for patients to spend more time with their doctors, are reviving the lost art of bedside medicine. It could be considered a move away from high-tech and back to high-touch medicine. 

Medical schools and teaching hospitals are working to help aspiring physicians understand both the value of bedside exams as well as how to perform them. 

They’re getting back to the basics, which include:

• feeling lymph nodes and differentiating benign enlargement from possible malignancy,
• evaluating patients’ walking for signs of neurological or musculoskeletal impairment,
• inspecting the tongue for the presence of infection,
• feeling the thyroid gland to check for enlargement,
• evaluating knees for pain and movement,
• listening to patients and their family members.  

The goal is to ensure that doctors rely less on technology and more on their ability to walk down the hall, evaluate a patient and then use the right tools at the right time–for the right reasons. 

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