In late 2010, McGill held a conference focused on improving the teaching of the physical. Among other things, key thinkers looked at how to impart to students the importance of this doctor-patient interaction, and how to properly examine bodies that deviate from the norm. “Nobody prepared me to examine a patient in a wheelchair,” says Dr. Donald Boudreau, a director at McGill’s Centre for Medical Education.
Boudreau is charged with developing courses in “physicianship,” which teach about the physician as healer and professional. Now, he is turning his attention to the physical. He wants to establish something similar to what Verghese is doing at Stanford—the McGill 25, perhaps. “Many people think the physical is the doctor’s way of making a diagnosis, and many medical schools teach it like that,” he says. “But it’s [also] a way to show that you care for a patient, to build trust, to reassure the patient. And it contributes to healing.”
A new Harvard study called “Placebos without deception” lends credence to that last notion. The “honest placebo” study revealed that the placebo effect manifests even in patients who are told they’re getting a sugar pill. A remarkable 59 per cent of participants reported relief of irritable bowel syndrome symptoms, compared to 35 per cent of those in the control group, leading doctors to wonder if patients benefit simply from the act of seeing a doctor.
It will take time for the culture of care to catch up to what people like Boudreau are advocating for in medical schools. For now, some practitioners are working to preserve the patient-physician relationship in their own way. Dr. Jackie Thomas, a gynecologist at Toronto’s Mount Sinai Hospital, occasionally uses manual exam techniques even when they aren’t essential for the results. “Patients want to be examined; it’s comforting,” she says. Thomas has noticed that skills around the physical exam are falling away. She says, “Some doctors won’t even look at the patient until they’ve had an ultrasound, and there are examples where [doctors] are treating a lab result, or treating an ultrasound result, and they are not treating the patient.”
Thomas is more realistic than romantic. Technology can outstrip certain physical exam manoeuvres when it comes to accuracy, she admits. An obstetrical ultrasound at 12 weeks can tell more about the size of the uterus than an manual exam could. “But there are other cases,” she says, “where the laying on of hands tells how we should operate, what tests to order, which incision we might use, whether a patient is sick.” A balanced approach means a physician can better care for his or her patient, and maybe even do that deceptively simple thing that Sir William Osler, Canada’s most famous physician, urged: “Listen to the patient; he is trying to tell you the diagnosis.”
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