Students of medicine find themselves deferring to their physical exam skills less in the course of their medical career, and understandably so. The advent of advance diagnostics has created a schism in not only preference of test over clinical exams, but the total amount of time doctors spend with patients.
Whether they are in their third year of schooling or 20-year veterans, the physical exam seemingly becomes a lost art reinvigorated by necessity in an era of technological advances and innovation. Eric Singhi, third year medical student at the Medical University of South Carolina (MUSC), found confidence in performing targeted physical exam maneuvers on a trip to Indore, India to visit his family and serendipitously screen patients in the world’s second most populous country.
“We sometimes ask ourselves as students, ‘why are we learning some of these examination techniques when there is likely a provided diagnostic test for it,’” questioned Singhi. “I quickly learned that tests aren’t available in many remote areas around the world.”
As recent as June 14, 2004 the United States Medical Licensing Examination (USMLE) renewed the clinical skills portion of the examination that was ended in the 1960s. This section of the examination, Step 2 CS, measures students’ ability to work through clinical observations of patients to deduce conditions. USMLE has since dramatically increased the emphasis of clinical skills learned through schooling.
Consensus from students shows that physical examination skills do fall by the wayside, but are sharpened when they serve in rural areas in the U.S. or abroad. “One important thing I have learned while abroad is to have confidence in using physical exam skills, and to have confidence, I have to use these skills often,” said Singhi.
By the end of his trip, Singhi had a greater appreciation for the physical exam which was bolstered by the constant reliance on his own natural and honed powers of deduction common among students of medicine. Singhi stumbled upon an opportunity to practice his clinical training abroad at Eureka Hospital in India by happenstance. Singhi at Eureka Hospital in Indore, India
Singhi’s father graduated from medical school in Indore, India. While at his father’s medical school class reunion, Singhi was introduced to one of his father’s classmates who had started a private hospital and thought it important for Singhi to witness first hand some of the differences in medical care offered in India as compared to the US. Singhi was eager to begin this opportunity not only to serve patients in his family’s hometown, but also to practice his developing craft in a resource poor setting.
Singhi admits that his early jump into preventive medicine abroad was not anticipated, but now a much appreciated and defining experience in his medical training. While at Eureka he realized the importance of preserving health of people long before the onset of chronic conditions and learned to value the universality of the human condition.
“I worked in community outreach and prevention services where I screened and examined patients for hypertension, diabetes and peripheral arterial disease,” explained Singhi. “It was here where I was able to practice physical exam maneuvers and perform diagnostic tests such as the ankle branchial index test (ABI). Performing these exams and speaking the local language both helped me to better relate with patients.”
Overutilization of advanced diagnostics, according to Singhi, begets tentativeness in physical examinations. Given the nature of medicine, it behooves professionals at all levels across disciplines to understand the costs of not resorting to hard clinical skills.
“The biggest differences in care was how confident and how much the physicians in Indore had to rely on physical exam skills rather than labs and tests,” Singhi said. “While I’m thankful that we have access to so many resources in the developed world like here at MUSC, at some point, and likely at a crucial moment, we will have to defer to our physical examination skills and I would like to work hard now to be prepared.”