My mother passed away in early December. She had been battling Alzheimer’s disease for several years. Her communication was poor due to the disease. The caregivers in the Memory Care Unit where she was located stated that she had been vomiting the night before her death. The next morning, she was moaning, and they believed she was in pain. An ambulance was called, she was taken to the local hospital. A CT scan of her abdomen was performed, and she was diagnosed with a perforated bowel due to a ruptured diverticulum with a belly full of fecal material, per the surgeon who called me. We declined intervention based on her Advanced Medical Directive. She was dead less than 12 hours later.
Some may say this was a blessing. No one, especially someone as vibrant and brilliant as my mother, would want to live the way she was living. I don’t disagree, but there is a lot more to this story.
My sister had taken my mom to see her primary care doctor not even one month earlier. He is an experienced physician who, a few years earlier, sold his private practice to corporate medicine, which now controlled how many patients he needs to see in a day.
Although the doctor did listen to mom’s heart and lungs, he did not touch her abdomen. (This is certainly not to say that he would have been able to find anything at that time, although we will never know that answer).
Days before my mother passed away, my sister took my father to this same doctor for back pain, a 20-pound weight loss and weakness. The doctor ordered a CT scan of his lungs and his abdomen, but, again, never laid his hands on my dad’s belly.
Long story short, my dad barely made it to my mom’s funeral. He was admitted to the hospital and was diagnosed with a large abdominal mass (discovered by the provider who did his admitting history and physical exam) that turned out to be Hodgkin’s Lymphoma. He passed away Dec. 29. Corporate medicine has not only taken over the physician-patient relationship, but it has impacted patient safety so negatively that potentially deadly outcomes are more common.
I’m angry and heartbroken, of course, but I’m also flabbergasted that physicians don’t put their hands on patients any longer, especially impaired patients. Full disclosure here: I’m a practicing OB/GYN physician, and I have been out of residency since 2002. I know exactly why physicians think other physicians don’t touch patients any longer, because I hear it from my frustrated peers.
Their schedules are packed so tightly that there isn’t enough time to lay hands on every patient. Nor is there enough time to think critically, talk about illness in depth, avoid antibiotic use (by thoroughly explaining why antibiotics might not be the best choice), or to complete the electronic medical record, among other things. In fact, a recent study published in the Journal of General Internal Medicine showed that there would need to be 27 hours in a day for a primary care physician to do all of the above appropriately for that doc’s patient load.
The advances in technology have made it easy to just order a test like a CT scan or an MRI, but who makes the money on the test? Certainly not the physician. And wouldn’t it just be cheaper to put hands on the patient? Medicine is never this black and white, but how can we possibly think that not touching our patients is the answer?
Another reason docs don’t lay hands on patients is because their individual specialty medical societies are telling them not to. Just Google “are physical exams necessary,” and you will see a large amount of debate on the issue. The pandemic did nothing to aid in this, as telehealth surged due to fear of contact.
There are some outside-the-box thinkers in medicine who have come up with ways to protect the doctor-patient relationship. One of my favorites is Direct Primary Care (DPC). In this scenario, the patient has a membership with the DPC’s practice. This gives the patient access to the doctor. The doc decides their own goal of how many patients they can handle in order to give the best care. Then the panel is capped. I realize that not everyone can afford a monthly membership fee to retain a physician, though prices do vary considerably, so I wouldn’t count it out without investigating. Even so, if enough people did it, it could lighten the load for the physicians who don’t offer DPC. Check out the website mapper.dpcfrontier.com to find a DPC doc near you.
As physicians, we talk so much about our broken system among ourselves, but the lay public needs to hear more. I know our country is struggling right now. There is a lot that needs to be fixed. The physical exam, however, was never broken.
Deborah Herchelroath (email@example.com) is an OB/GYN Hospitalist at UPMC Harrisburg Hospital in Pennsylvania.