Inefficient Physical study misses the point

The LATimes has discovered for the ninety fifth time that annual physicals are useless...DUH.

Many of our screening tests are useless, or don't discover cancer or disease significantly early enough to make a difference in the cure rate than if we waited for them to cause symptoms...

The answer: Screen things you expect to find...duh...

That's what we already do.

The important "efficiency" part of all this is this: ""The physical exam takes time that could be better spent, especially if a doctor only has 20 minutes before the next patient," says Dr. Harold C. Sox, editor of the medical journal, Annals of Internal Medicine."

Hello. You CAN't do a decent physical in 20 minutes...

and the real reason to bring people in for physicals is the same reason that an M.D. with 11 years post high school education will see people with simple colds: so that you get to know them, so that when they come in with terminal cancer, or with pre infarction angina, or even with insomnia because they are going thru a divorce, the doc is not a complete stranger, but a family friend who you trust...

at least the article notices this: "But some doctors say the annual physical might help in ways not easily captured by studies. "The physical also carves out a time for counseling on important lifestyle choices..."

Yes. We get to know people, and giving advice is more effective if the person knows you and your family...

We Docs do profiling...yes, I know this is a dirty word, not politically correct. But we do it...

If you were a Native American, were overweight you got a random blood sugar even if you merely came in for a cold...if you were black, blood pressure was checked EVERY visit...ditto for traditional Asians...All women were checked for gynecology matters, even if they didn't come in for a pap smear...

Notice the tobacco odor? Smokers were chided and instructed how to stop smoking...Note the acne rosacea and faint tinge of alcohol? Alcoholics and their families ditto....does the patient make you feel depressed? They probably have depression: check about marital problems...did you hear a rumor about Mrs. Smith's husband at the country club? Better suggest she get checked for STD.... there are a lot of little things were probably more important than giving out medicine...

Take sports physicals...completely useless (except for an occassional heart murmur we picked up)....but it helped the teen to get to know us...

I would screen teenaged girls coming in for a cold or sports physicals for painful periods and seuxality ...about once a year a "good" pregnant teen hiding the pregnancy from her parents was picked up.....others were placed on the pill because they were sexually active, but were too shy to mention it. Similarly, the boys were told about condoms and the fact that girls can become pregnant...and many were given treatment for acne, which was embarassing but not something one went to the doctor about...

Many older women coming in for paps just wanted a shoulder to cry upon...and prozac was a godsend for menopausal mood swings. But what also came up was the spousal abuse, the alcoholism, the drug abuse in the patient or a family member...again, counselling was the answer.

And men who are suicidal often see their docs but don't mention anything is wrong...again, often you sense something is wrong, and start counseling and medication and often referral...

Psychiatrists call this "countertransference"...cops call it "gut instinct" and women call it "intuition", but this sense of something being wrong is part of the art of medicine...and when the HMO insists you see 30 patients a day, are encouraged to do fancy tests (that insurance companies pay for) instead of time simply talking and checking the patient, and then spend more time "documenting" problems than talking to patients, such little clues to the real things that bother our patients can be missed...

That is why you "lay on hands"...it is a ritual...But you don't merely touch. You do an exam while talking about things...and the touching establishes an intimacy....not to mention that you sometimes see things that would be missed....

I've picked up two late stage breast cancers in elderly women who were too shy to mention their lemon sized breast lumps...until I did a "routine" exam of their heart and lungs...