I think the history and physical is necessary. I like sitting an listening. Maybe it stems from being blessed with 3/4 of my grandparents being alive into my 20-30’s. Listening to old world war two stories from my grandfather that had a fabulous recollection of detail, old photos and a diary to help him remember. A grandmother who vividly recalled the depression days and described how to survive on a non existent preacher’s salary in the hills of West Virginia.
Believe it or not, despite the flurry of activity on the twitter site, I am not much of a talker. So I suppose, I was molded early on to be a good listener. But it does come in handy with the essentials of the making of a good internist, and that is taking a good history, often time listening and knowing when to direct the history and how to get to the diagnosis.
This skill helps accentuate honing in on the portion of the exam to concentrate on to clinch the diagnosis before any testing or xrays are ordered.
So, I am the first to admit, I love integrating a lot of the new technology into the office and exam room setting, but the good old history and physical can never be supplanted.
The technology flows from this essential part of the patient doctor relationship, and if one can find an electronic record that improves and enhances this core feature of the physician’s role, then one is on the right track.
I had a patient, who said she would not mind if I used her as an example, but with the technology, was very impressed with the visual portion of the encounter, and found going through the electronic chart very helpful. She did say this appointment is the best she ever had.
I think if you can give back to the patient by sharing their record visually, or message electronically to the office at 11 pm in the quiet of their home, I think you are on the right track. However, these tools do not supplant the fundamental skills of a physician, the good old history and physical.