In September 2016, the American Medical Association held a funeral service to physical examination. Medical imaging is gradually replacing the age-old conventional practice of history-taking and clinical examination. Our legendary and eminent gurus made bedside diagnosis just with history and physical examination (which includes percussion and auscultation), which was confirmed by minimal investigations available those days. Sometimes, even without investigations, their diagnosis was accurate.

With the burial of physical examination, patients need not be touched or examined and can be straightaway subjected to a battery of investigations suggested by algorithms. The physician thus loses the thought process and judgment and can bid farewell to the stethoscope as auscultation will be redundant. It wont be long before robots will replace the physician and take the history and feed it in the computer and print out the investigations required. The physician needs to give only the prescription.

Now, skin patches monitor real-time blood glucose levels, automatic blood pressure recorders display the readings on mobile phones and electronic loop recorders monitor heart rhythms round the clock through telemetry. Many scans are reported online from distant locations without examining the patient.

During practical examinations for trainees, it was customary for the examiners to ask for provisional diagnosis soon after the history. Again after physical examination, the examinee is assessed for his or her capability of arriving at a reasonable diagnosis. With the burial of physical examination, is it necessary for the trainees to be subjected to such a rigorous assessment? Training physicians to make diagnosis without physicals is like teaching algebra and calculus without teaching division and multiplication. Similarly, a musical exponent cannot achieve perfection without learning basic notes and ragas.

When physical examination becomes obsolete, there wont be any need to touch the patient. This will replace the age-old practice of doctor-patient relationship and it can be renamed a computer-patient relationship. Such a patient can be called an e-patient. This will defeat the concept of family physicians which still exists in our country. It is the touch of the physician which gives the healing effect to the patient, the so-called Hastavasi (the healing touch).

With the entombment of physical examination, is it necessary to increase the number of medical colleges and medical seats when the future is going to be dominated by computers and artificial intelligence? This aspect is debatable, and policy makers and health-care providers must give a serious thought to this.

I predict, however, that the buried physical examination will definitely have a resurrection.

isathya@hotmail.com

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When medicine loses the healing touch - The Hindu