Approximately 20 years ago, my physician mother and I attended a conference focusing on heart sounds. For 3 days, she and I wore headphones while the cardiology instructor painstakingly reviewed murmurs, arrhythmias, and other abnormal heart sounds. I was a (much) younger medical student at the time and my mother wanted to be certain I understood the art of the physical exam.
As technology advances however, I fear the art of the physical exam will go the way of the dinosaurs and disappear or at least become much less significant.
Speaking at the American Academy of Family Practice (AAFP) Assembly this month, Dr. Eric Topal MD suggested many of our routine medical practice devices could quickly become “relics” as we all advance our technological services. As a cardiologist, Dr. Topal uses his smart phone for just about everything.
He ditched his stethoscope and stopped taking patient’s pulses. Instead, he is able to get more information from his smart phone. He demonstrated the technologically advanced use of his smart phone as an echocardiogram (heart ultrasound device); in addition, he demonstrated use of the phone as a glucose monitor, blood pressure and heart rate tracker.
Recently, I attended a dermatology (skin) conference where a microscope device attached to my iPhone allowed me to more clearly image and diagnose precancerous or cancerous lesions. Surprisingly, these devices were affordable.
A recent study found that handheld ultrasound was more likely to detect abnormal heart problems compared to a physical exam using the standard stethoscope. The study suggested a savings of $63 per patient with the use of handheld devices versus hands-on evaluations.
Dr. Topal reminds us that most Americans (“90 percent”) are upset with health care costs. He suggests smartphone technology translates to less costs. That makes sense. I already use several Apps for patients to assist with their diagnosis and testing and therefore more careful about ordering unnecessary tests.
Could you imagine a single hand-held device that evaluates all your vital signs (heart rate, temperature, blood pressure) and then predict your heart risks? Personally, I want a device that with a single drop of blood could analyze entire blood profiles for anemia, thyroid disease, diabetes, etc. and I want the results within minutes (or seconds). Don’t keep me waiting (Just ask my staff…I am high maintenance).
The technology is here. The medical field needs to take the initiative to pull it into our practices. Admittedly, we are slow to change. Approximately 83% of doctors have implemented electronic records. That means that over 15% of doctors still use paper charts which need to go the way of the dinosaurs.
But is the hands-on physical exam ever going to go away? I hope not and I still believe that touching and laying hands on a patient is best medical practice. There is something overwhelmingly personal about the physical exam that can never be replaced by a handheld device.