seeks to manage without it?
——
Steven McGee, a mild-mannered man with a serious face, an FM radio voice, and a scholarly passion for the physical exam, has blazed a rational trail deep into that middle ground. As an internist and a professor of medicine at the University of Washington, he embraces technology but also believes that the physical exam has uses that machines cannot replicate. McGee’s research is an outgrowth of his own experiences in medicine, and his book, Evidence Based Physical Diagnosis , outlines the evidence for the utility of the physical exam in the age of high technology.
When I spoke with McGee about his work, he was eager to tell me about examples from his own experience of medicine that proved to him the fundamental importance of examining the patient. He recalled a particularly dramatic case that had occurred just a few weeks before we spoke.
McGee and his team of residents and medical students were called to see a patient on a surgical floor. The patient had come to the hospital for the excision of a skin cancer on his ear. That morning he’d developed severe abdominal pain, and the plastic surgeons had asked them to help figure out what was going on.
Michael Killian, a thin elderly man, lay on the bed with his eyes wide open, moving restlessly as if he couldn’t find a comfortable position. He muttered incoherently as he shifted awkwardly across the bed.
The resident introduced himself to the distraught patient and immediately began asking questions. “I don’t know. I don’t know. I don’t know,” was his only answer. It quickly became clear that the elderly man was too confused to provide any details about his pain. He could tell them his name. But he didn’t seem to know that he was in the hospital or why. All he could say was that he hurt. When the resident asked if he had pain in his belly, he started his litany once more: I don’t know, I don’t know.
His skin was pale and littered with scaly patches of red, evidence that he’d spent too many hours in the sun. The ear that had brought him to the hospital in the first place was enlarged and distorted by a raised red and scaly lesion at the tip. His unshaved cheeks were gaunt, his cheekbones sharply defined, his eyes seemed focused on something in the room no one else could see. A fringe of white hair was well cut but uncombed. His skin was cool and damp with sweat. It was difficult to examine him because ofthe constant restless movement. His heart was fast but regular. So was his breathing. When the resident moved to examine the patient’s abdomen, he jerked away. “No. No. No. Don’t touch me.” The distant eyes were now back in the room, glaring at the young doctor. The patient waved his arms in a way that suggested that no means no. The doctor quickly pulled back.
“No. No. No.”
The resident leaned down and began to speak in a quiet voice to the distressed man. “I know you are in pain and I want to help you. But in order to help you I need to touch your stomach. I won’t hurt you.” The soothing tone eventually quieted the suffering man, though he continued to shift his position on the bed, as if the soft mattress had been replaced by a bed of nails.
As the resident reassured the confused and frightened man, McGee gently placed his hand on the upper left side of the man’s abdomen. He felt an unexpected resistance in the normally soft region of the belly and quiet steady pulsations. He placed his other hand over the man’s navel. A soft mass throbbed beneath his fingers, pushing his fingers away to the right. And that told him everything he needed to know.
“Call the surgeons,” McGee told the resident. “This man needs to go to the OR. He’s got a rupturing aortic aneurysm.”
The aorta is the vessel that carries blood from the heart to the rest of the body. Patients with hardening of the arteries and high blood pressure—like this man—can develop areas of weakness in the normally thick
——
Steven McGee, a mild-mannered man with a serious face, an FM radio voice, and a scholarly passion for the physical exam, has blazed a rational trail deep into that middle ground. As an internist and a professor of medicine at the University of Washington, he embraces technology but also believes that the physical exam has uses that machines cannot replicate. McGee’s research is an outgrowth of his own experiences in medicine, and his book, Evidence Based Physical Diagnosis , outlines the evidence for the utility of the physical exam in the age of high technology.
When I spoke with McGee about his work, he was eager to tell me about examples from his own experience of medicine that proved to him the fundamental importance of examining the patient. He recalled a particularly dramatic case that had occurred just a few weeks before we spoke.
McGee and his team of residents and medical students were called to see a patient on a surgical floor. The patient had come to the hospital for the excision of a skin cancer on his ear. That morning he’d developed severe abdominal pain, and the plastic surgeons had asked them to help figure out what was going on.
Michael Killian, a thin elderly man, lay on the bed with his eyes wide open, moving restlessly as if he couldn’t find a comfortable position. He muttered incoherently as he shifted awkwardly across the bed.
The resident introduced himself to the distraught patient and immediately began asking questions. “I don’t know. I don’t know. I don’t know,” was his only answer. It quickly became clear that the elderly man was too confused to provide any details about his pain. He could tell them his name. But he didn’t seem to know that he was in the hospital or why. All he could say was that he hurt. When the resident asked if he had pain in his belly, he started his litany once more: I don’t know, I don’t know.
His skin was pale and littered with scaly patches of red, evidence that he’d spent too many hours in the sun. The ear that had brought him to the hospital in the first place was enlarged and distorted by a raised red and scaly lesion at the tip. His unshaved cheeks were gaunt, his cheekbones sharply defined, his eyes seemed focused on something in the room no one else could see. A fringe of white hair was well cut but uncombed. His skin was cool and damp with sweat. It was difficult to examine him because ofthe constant restless movement. His heart was fast but regular. So was his breathing. When the resident moved to examine the patient’s abdomen, he jerked away. “No. No. No. Don’t touch me.” The distant eyes were now back in the room, glaring at the young doctor. The patient waved his arms in a way that suggested that no means no. The doctor quickly pulled back.
“No. No. No.”
The resident leaned down and began to speak in a quiet voice to the distressed man. “I know you are in pain and I want to help you. But in order to help you I need to touch your stomach. I won’t hurt you.” The soothing tone eventually quieted the suffering man, though he continued to shift his position on the bed, as if the soft mattress had been replaced by a bed of nails.
As the resident reassured the confused and frightened man, McGee gently placed his hand on the upper left side of the man’s abdomen. He felt an unexpected resistance in the normally soft region of the belly and quiet steady pulsations. He placed his other hand over the man’s navel. A soft mass throbbed beneath his fingers, pushing his fingers away to the right. And that told him everything he needed to know.
“Call the surgeons,” McGee told the resident. “This man needs to go to the OR. He’s got a rupturing aortic aneurysm.”
The aorta is the vessel that carries blood from the heart to the rest of the body. Patients with hardening of the arteries and high blood pressure—like this man—can develop areas of weakness in the normally thick
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