DEAR DR. ROACH: In your response to “R.J.” in your column “In exams, doctors seem to have lost their touch,” you missed an opportunity to educate the writer on the role of the physical examination. There still is a role for the physical exam, but the evidence supporting a “complete” physical in asymptomatic people is lacking. Time that is spent looking in ears, feeling for swollen glands, etc., in people who have no symptoms or problems that warrant checking those areas can better be used to focus on examining parts that are relevant to the patient’s medical problems, or on discussing recommended screening tests or health behaviors (such as smoking cessation).
While it may be true that in some cases, the physical examination is a victim of time constraints, in others it is a matter of using the same amount of time more effectively. This is no different from how we should approach other types of “tests,” such as blood or imaging studies. Don’t do lots of things for the sake of doing lots of things and being “thorough”; do what you need to do to meet the needs of the patient, based on her or his individual risk factors, history and symptoms. — Yul D. Ejnes, M.D., MACP, Chair Emeritus, Board of Regents, American College of Physicians
DR. ROACH RESPONDS: Thank you, Dr. Ejnes, for taking the time to write a thoughtful response. The physical exam is an important part of the doctor visit, and it has variable necessity, depending on the reason for which the patient is there. A reasonably complete physical exam probably makes sense on the first visit and then on an as-needed basis.
DEAR DR. ROACH: My 58-year-old girlfriend smoked cigarettes for 30 years. She quit 10 years ago with the help of nicotine gum. The problem is that she still chews the gum — constantly. She is never without it, constantly changing for a new piece. I am concerned for her health. Isn’t this product full of carcinogens? I cannot believe this long-term use can be good for her. What is the truth about long-term use of nicotine gum? — D.B.