The examination and the Patient/Doctor interaction

After the interview, the doctor then proceeds to examine you or do what some call “a physical”. The physical examination is actually not the best description, as we also do a mental examination as well as a physical. The examination starts when the patient enters the interview room. The way he or she walks in, the way he or she answers the questions, the way they express themselves.{{more}} The “physical” is then only a part of the examination, even though, for most doctors, it is the main part. It involves looking, feeling or palpating, percussing or knocking and listening. In other words, we are medical detectives. We detect the presence of disease, so omission of any of the above steps leads to misdiagnosis. This is so important as most of the patients I see, who come for a “second opinion”, have had their diagnosis missed because of an omission of one of these steps. You’d be surprised at how many times I am called for an opinion by one of my juniors who have not examined the patient!

Your doctor MUST examine you before he comes to a conclusion as to what’s wrong. Let’s say you go to a doctor with a lump in the groin that you think is a hernia. He listens to you and then asks a few questions. Suppose he does not examine you, then he might misdiagnose a hydrocele, or a testicular lump, or a dilated vein (called a varix), or a lymph gland, or a lump of fat for what he is biased to believe is a hernia. The steps of the physical examination dictate that the doctor looks at the lump, touches or palpates the lump and possibly auscultates or listens to the sounds coming from the lump using his stethoscope. It is only after these steps that he can say with some certainty that you do or do not have a hernia. It is only AFTER the examination that he is qualified to order tests. The physical exam helps us to decide what tests are needed. Without the physical exam, unnecessary and expensive tests may be ordered.

I do not think that our population is informed enough as to the in-workings of the medical profession. Patients who pay a doctor should expect value for money. They should expect to be examined properly. They should demand value for money. Having a doctor is like having a relationship. It is usually a long-term commitment. Jumping from one doctor to the next is not the best thing, as the longer you have been with your doctor, the better he is able to help you. Every new doctor has to start over. It’s like changing partners in a relationship; every new partner you have is a “new beginning” and “a rolling stone gathers no moss”. If you have not received help for the same problem from your regular doctor, you should ask for a referral. Within this relationship “honesty is the best policy”. It is dishonest to turn up at another doctor for a “second opinion” without informing them that you have had a “first opinion” from another doctor, especially if the doctor asks. This makes for a bad relationship with both doctors and there are some patients who manipulate the system, trying to get the best results. This only leads to bad results.

The doctor should be able to recognize his limitations and be mature enough to not be offended if the patient asks to be referred. It is the your right, but it should be done properly. The referral should be written and should be accompanied by the appropriate test results, unless it is an emergency, in which case a verbal referral will suffice, if it is “doctor speaking to doctor”.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com