Annals of Family Medicine. 2019 jul; 17 (4) : 304-310.
Martina Ann Kelly, Lisa Kathryn Freeman, Tim Dornan
PMID: 31285207
PURPOSE: The increased availability of reliable diagnostic technologies has stimulated debate about the utility of physical examination in contemporary clinical practice. To reappraise its utility, we explored family physicians’ experiences.
METHODS: Guided by principles of phenomenology, we conducted in-depth qualitative interviews exploring 16 family physicians’ experiences of conducting physical examination: 7 (44%) men and 9 women (56%) whose clinical experience varied widely, from 11 (69%) urban and 5 (31%) rural locations. We recorded the interviews, transcribed them verbatim, and identified initial themes using template analysis. We worked reflexively, critiquing our own and other team members’ interpretations, in order to synthesize and write a final interpretation.
RESULTS: Participants described 2 facets of physical examination: making diagnoses and estimating prognoses rationally and objectively; and responding subjectively and intuitively to patients’ illnesses, which formed relationships between doctor and patient that enacted medical care in the moment. Physical examination allowed physicians to use their own bodies to experience patients’ illnesses. Performing physical examination was integral to being a family doctor because it promoted rapport and developed trust.
CONCLUSIONS: Physical examination is part of the identity of family physicians. It not only contributes diagnostic information but is a therapeutic intervention in and of itself. Physical examination contributes to relationship-centered care in family practice.