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Physical Exams: Why They Can Be Unnecessary, Ineffective, and Costly

Posted by Scott Orava, Aug 25, 2015

It’s a classic scenario: Your patient sits quietly on the edge of the examination table in a dressing gown waiting for you to walk in the door. Within the first few minutes, you examine her facial expression and body language, hold a conversation about her symptoms, and briefly scan her medical history. You can see she’s feeling discomfort, hear that she has at least two or three of the classic symptoms of a urinary tract infection, and read in her history about past occurrences of UTIs.

At this point, you don’t need to order tests or perform any type of physical examination to know this woman more than likely has a UTI. The patient will probably also tell you she thinks she has a UTI, but she wanted to come see you to be sure.

In short, the entire visit could have been conducted within minutes via a telemedicine consult, which could have saved both you and your patient time and money.

How often does this happen to you? In my case, four or five patients I see in a day come in with ailments that did not require a moment of physical examination. In fact, I would venture a guess that 50% to 70% of what physicians see on a regular basis are diagnoses that require no physical examination and could be performed via a quick video call and scan of the patient’s medical history.

How much time and money could we save if we started replacing these appointments with telemedicine visits?

In many cases, physical exams are unnecessary, ineffective, and costly to physicians, patients, and even the staff at your practice or hospital.

Unnecessary

The scenario above is just one of the most common diagnoses I see where a physical examination is unnecessary. Others might include upper respiratory infections, the flu, rashes, common abrasions or lacerations that don’t need to be sutured, and medication refills. There are two main reasons why physical exams are often unnecessary.

Classic symptoms and history often tell it all.

If a patient has two or three classic symptoms of a UTI, she has about a 96% chance of having one, especially if she has any sort of history of such an infection. Many of the other diagnoses I mentioned also have telltale symptoms common for most patients, and a patient’s medical history is the other primary component of my determination of a diagnosis. For many of these common diagnoses, I already have a pretty strong idea of what’s going on with the patient before a physical examination or having to order any tests.

Much of our diagnosis process is visual and doesn’t require touching a patient.

I don’t know about you, but when I first see a patient, I can often tell right away whether that patient is sick or not. A patient’s facial expressions and body language can very clearly indicate whether he is sick or not, based on a visual level of discomfort. But I don’t need to be in the same room as my patient to make that visual evaluation. I can just as easily see the patient remotely via a telemedicine consult and come to the same conclusion without ever putting a hand or stethoscope on the patient.

Now, I know one barrier for some doctors is wanting to collect vital signs before diagnosing a patient. While I myself don’t find vital signs to be necessary for all diagnoses, I can see the issue there. However, many patients, particularly in the older generations, are starting to keep machines at their homes that can take their vital signs without a doctor being present. The patient could either give that information to her doctor verbally or wirelessly transmit the data to her electronic health record in the doctor’s hand. Wearable technology and smartphone apps can also help physicians remotely collect vital sign information.

Ineffective

Physical exams can be ineffective for certain conditions when it comes time to making a diagnosis. When diagnosing a UTI, for example, what good would a physical examination do? You could run a urine test, sure, but when the patient has the common symptoms and the history, is that test really an effective use of your (and your patient’s) time and money? For common diagnoses like a UTI, meeting with your patient in-person is not always effective for making your medical diagnosis anyway.

Costly

Unnecessary and ineffective exams are costly. Think of how much time you could save in a day if you could do quick telemedicine consults with patients that have these common, easily diagnosable ailments. With fewer appointments, you could reduce your office hours, and thereby reduce your overhead. Plus, you could fit in more telemedicine consults in any given day, increasing your revenue for the sameamount of time worked.

Your patients will save time and money as well. They won’t have to find childcare or pay for the gas it takes to drive to the doctor’s office, which is particularly important for patients in rural areas. As for time, think about the time it takes for a patient to drive to the appointment, register with the front desk, sit in the waiting room, be taken to a room, wait for you or me to come in and perform the examination, and then drive back home. All that time could be saved by a brief telemedicine consultation which patients could conduct from the comfort of their own home, no driving required.

Certainly, physical exams are recommended, (if not explicitly necessary) in a variety of health situations. I’m not arguing against their value in those scenarios. Physical exams are a crucial part of diagnosis for many medical conditions.

However, I do think we as physicians need to take a closer look at our day-to-day patient schedules and consider – is a physical exam absolutely necessary for this minor check-up? Could I change this appointment to a telemedicine visit and cut time and costs? If physicians all start thinking this way, we’ll start to see a huge change in the healthcare field.

 

Topics: eVisit Blog Posts, care provider, diagnosis, examination, Medical Practice, physical exam, physician patient relationship, Practice Management, profitability, revenue, telehealth, Telemedicine

Scott Orava

About Scott Orava

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