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Calls Go Out to Revive the Traditional Physical
Date:1/28/2011

CT scans subject the body to harmful radiation.

It's also possible that a test or image alone won't reveal what's wrong with you, said Dr. Nesli Basgoz, a physician at Massachusetts General Hospital.

"Imaging can't tell you how the patient is doing, the way talking to them and seeing them can," she said. "And if you don't know where to look, you might go looking in the wrong place. You might order a CT scan of the brain when the problem is in a peripheral nerve. You might image the completely wrong part of the body."

Unnecessary testing also is expensive, contributing to the upward climb of health-care costs. For example, routine blood testing and urinalysis alone costs the U.S. health-care system about $80 million every year, Duane wrote in an editorial in American Family Physician.

What to do? Medical experts are grappling with ways to combat overreliance on scans and tests.

Part of the answer may lie in teaching the newest generation of doctors the importance of taking a thorough patient history and performing a detailed physical examination.

"You need to start in the med schools by focusing on physical diagnosis skills," Duane said.

Stronger relationships between a person and their physician also can help, Stream said, by giving doctors more knowledge of the patient before they even walk through the door.

"I get to know them over time," he said. "The physician knows more about the patient, and the patient develops a very important measure of trust in their physician. I know their history. I know what they do for work. And that helps me diagnose without having to resort to a test."

Reestablishing the value of the physical examination could pay off huge benefits in the long run for the doctor, the patient and the entire health-care industry, Basgoz said.

"There's no question in my mind that people who are alert and observant do make diagnoses that can't be performed using a test," she said. "That's
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