Role of Physical Examination in 21 st Century What If the Revolution Lies Within our Reach?
Sciences de la Santé
Role of Physical Examination in 21 st Century What If the Revolution Lies Within our Reach?
Yanis AFIR
Physical examination has always played a very important role in medical practice. However, it has lost a consequent amount of its value to new technologies and diagnostic methods. In this short review, we will discuss some of the issues faced by classic bedside physical examination in order to keep up with the challenges of the 21 st century.
Even though the topic of this issue is The History of Medicine, we might have, confidently, written this article in the previous one. Indeed, in this era where technology dominates and primary care has nearly lost its humanistic dimension, the classical physical examination and the dogma it represents plays a very important role in keeping the balance in medicine and might truly be the next“ Cutting-Edge” of medical practice. A real revolution might very well come from our stethoscopes and reflex hammers...
Bedside physical examination has been a part of medicine from the beginning. Actually, for a very long time, its first pillar, the observation( or inspection), represented almost the whole of medical practice. However, physical examination really took a step forward and became truly scientific or“ clinical” starting only from 18 th century. Two main events mark this period. First, in Austria, Joseph Leopold von Auenbrugger observed his father, an innkeeper, tapping on barrels and, from the produced sound, establishing whether wine has yet reached the proper quality. Auenbrugger tried to use the same technique to detect abnormalities in the chest and described it in his book“ Inventum Novum”. This is how Percussion was born and added to physical examination.
Few years later, in Paris, René Lænnec, finding it somewhat inappropriate to stick his head in young ladies’ chests in order to listen to their hearts, had the idea of a little cylinder which he used to listen to heart abnormalities from a safe distance. After describing this tool in his book“ De L’ auscultation Mediate, Traité du Diagnostic des Maladies des Poumons et du Cœur,” people developed it, and later it led to the stethoscope. The invention and development of these new techniques brought a real revolution in medicine; in fact, we can state that modern medicine was invented in that era, as it was only then that healers really started making diagnoses.
However, we can easily notice a net drop in
the classical bedside medicine in favor of new technologies. Technologies, of course, are necessary and have led to many breakthroughs in medical research; however, considering the primary healthcare and the way we deal with patients, it is sad to realize how we moved from a philosophy of medicine in which the patient is in the center of the inquiry to an environment full of computer devices and TV screens, where most of the discussions( and studies) occur away from the patient.
Luke Fildes – The Doctor. 1891. Source The image above is a famous painting by Luke Fildes named“ The Doctor”. We are not quite qualified to play the art critic, but something is really interesting about the painting: Fildes has perfectly captured the medical spirit of his era. A Doctor, sitting in a chair and looking at a sick little child. There is no physical barrier between them( indicating probably that there is no psychological barrier either). There is no book, no instrument and no complicated data or sophisticated machine; his eyes stare at the little child, not disturbed by the cup of tea that he had been given, nor the mother’ s tears. The father seems to not even dare talk to him. The Doctor seems to have interrupted all the circuits of his brain to focus on one task only, saving this little girl... Alright, we may have exaggerated a little bit, but you get the point!
10 Printemps 2018