Is the veterinary physical exam toast?

Hey, look at me! (Shutterstock)

Editor's note: In 2008, Dr. Robbins wrote an article for Veterinary Medicine on the dying art of the physical examination in veterinary practice-new technology making the actual contact time with the patient cursory at best, its de-emphasis in veterinary school, and more. It's been nine years, and technology only continues to make the physical exam more diminished in importance compared with other forms of testing, let alone general assessment during a wellness exam. We thought it was time to revisit this vital touchpoint and asked Dr. Robbins for his continued thoughts.

As veterinary medicine continues to evolve, we are faced today with technologic advances that not only challenge the traditional ways we diagnose disease but also how we interact with our patients. In an era of rapid technological growth, it is easy for clinicians to become more reliant on laboratory tests and advanced diagnostic modalities that are widely available and promise greater insight into disease processes.

However, with the overreliance on technology comes the possibility of devaluing the physical exam. An example of this is in the area of telemedicine. Although telemedicine affords the clinician the opportunity of remote consultation, it has the potential for eliminating the performance of a physical exam all together. By neglecting the physical exam completely in the diagnostic workup of a patient, clinicians risk misdiagnosing and mismanaging cases.

Although new technologies allow veterinarians to explore parts of the body that they can't examine any other way-they don't give the whole picture. Technology can't feel where an abdomen is tender or discern clues about how a patient feels from the look on its face. Technology should be viewed as an extension of the physical exam rather than a replacement.

We still must remember that beyond its historical and ritualistic significance, the physical exam is still a diagnostic modality that requires only the hands, eyes, ears and mind of a veterinarian. It allows us the opportunity of seeing patients and helps to develop and strengthen the veterinarian-client-patient bond. The physical exam can help to guide patient therapy and be vital for assessing prognosis. It is also a vehicle for teaching clinical reasoning and bedside manner. It gives students the opportunity to not only practice their practical skills but also to interpret them and make clinical decisions.

As a profession we must not abandon the physical exam for the sake of technology. Instead we need to embrace both of them and remember that practicing veterinary medicine starts at the bedside with observing, examining and connecting with our patients.

Dr. David Robbins is a small animal practitioner with more than 30 years of experience in the veterinary field. He is the medical director of VCA West Bernardo Animal Hospital in San Diego, California.