The Primary Care Physical Examination in the time of COVID
In this time of COVID, many people are using some form of Telehealth options. In my jurisdiction we can use phone calls, or video calls to talk to our family doctor, as visits to clinics and the Doctors office are not yet back to normal. If people want in person care they can go to the emergency room. More and more people are doing this as we settle into our new normal. In an online Journal from Jama Internal Medicine there was an interesting article on Telehealth from a Doctors Perspective, which I thought was interesting. Here is some of what the Doctor said. For the complete link to the PDF article see the end of this post.
Many physicians would say that some diagnoses cannot be made without examining a patient in person. I am not sure how I am supposed to distinguish central vs peripheral vertigo, diagnose otitis media, or determine if someone has orthostatic hypotension without examining a person in front of me. In addition, many of us have cases where an unanticipated finding on examination feels as though it saved a patient’s life. A discovery of an irregular mole, a soft tissue mass, or a new murmur—I do not forget these cases, and I do not think the patients do either.
Finally, the physical examination is one of my routines, 15 years in the making, that has been taken away with the emergence of the pandemic. Starting with the principles of active listening, gathering data, and creating a broad differential, I had developed a way of practising medicine that I felt worked often. While I continued to revaluate this process, I did not question each day whether a patient needed a physical examination. But the pandemic has forced me to deconstruct my routine, including the physical examination, in a way that leaves me on uncertain ground. This has been emotionally exhausting and unsettling.
Not all is lost with the emergence of telehealth. At least in these early phases, virtual visits seem to allow me to connect more frequently and easily with patients. With telehealth, I can see patients in their home environments, which often provides me with new information on factors that influence their health behaviours. Virtual visits respect a patient’s time. And, of course, in this pandemic when social distancing is so important, telehealth keeps patients safe. As the months go by, I will adapt and undoubtedly learn new ways to gather physical examination data. Wearable technology or guiding patients through self-examinations will offer some creative approaches to obtain tele-examination findings.