The Importance of a Complete Physical Exam

An internist was mentioning that his patient declined a physical examination of her body and only wanted tests performed, including a mammogram that came back with a normal report. She had felt a lump for several months which she had not disclosed to her physician. After another three months or so she decided to come back and have her doctor examine her since she felt this large lemon-size mass in her breast just under the skin could be important, even if it was not seen on the mammogram. It turned out to be a ductal carcinoma. Some of her lymph nodes were positive. She had such faith in modern technology that she tried to bypass the standard procedure of a medical evaluation. It may have cost her her life.

A traditional medical evaluation first includes the complete medical history, which requires about 30 minutes on the initial visit and gives about 65 percent of the information necessary to determine the diagnosis. The complete physical examination, which takes about another 15 minutes, confirms this information and may give 10 percent further diagnostic information. The last 15 minutes of the first hour on a new patient is used to begin treatment and to determine what further laboratory, x-rays and other tests are needed. This treatment and further testing improves the diagnosis another 15 to 20 percent. The information becomes available and is discussed on the return visit. Thus, an amazing 90 to 95 percent of a diagnosis is established by one consultative and follow-up visit when following this routine. Of course, follow-up examinations may take only 10 or 15 minutes but always rely on the recorded detail of the initial complete examination.

The lady mentioned above, by avoiding the physical examination of her breast, delayed treatment of her cancer more than six months. It is possible that the cancer spread may have occurred during this six-month period of relying on technology rather than the results of the full examination sequence. As IT use increases and streamlines many of the steps involved, it is even more important that your physician evaluate all the data on a continuing basis. It is the patient’s life that is always at stake.

An Alzheimer Story

It was a busy morning, approximately 8:30 am, when a gentleman in his eighties arrived to have stitches removed from his thumb. He stated that he was in a hurry as he had an appointment at 9:00 am. I took his vital signs and had him take a seat, knowing it would be over an hour before someone would to able to see him.

I saw him looking at his watch and decided, since I was not busy with another patient, I would evaluate his wound. On exam, it was well healed, so I talked to one of the doctors and got the needed supplies to remove his sutures and redress his wound. While taking care of his wound, we began to engage in conversation.

I asked him if he had a doctor’s appointment this morning, as he was in such a hurry. The gentleman told me no, that he needed to go to the nursing home to eat breakfast with his wife. I then inquired as to her health. He told me that she had been there for a while and that she was a victim of Alzheimer Disease.

As we talked, and I finished dressing his wound, I asked if she would be worried if he was a bit late. He replied that she no longer knew who he was, that she had not recognized him for five years now. I was surprised and asked him, “And you still go every morning, even though she doesn’t know who you are?” He smiled as he patted my hand and said.

“She doesn’t know me, but I still know who she is.”

I had to hold back tears as he left, I had goose bumps on my arm, and thought, “That is the kind of love I want in my life.” Love is neither physical, nor romantic. Love is an acceptance of all that is, has been, will be, and will not be. With all the jokes and fun that is in the emails, sometimes there are some that come along that have an important message, and this is one of those kind. Just had to share it with you all.

Peace is seeing a sunset, and knowing who to thank.

Anonymous, RN

Disclaimer:
These messages were written in the years as noted and may be somewhat dated at this time. Please consult your physician or other health care provider.