Of course, we still teach medical students how to properly examine the body. In dedicated physical diagnosis courses in their first and second years, students learn on trained actors, who give them appropriate stories and responses, how to do a complete exam of the body’s systems (circulatory, respiratory, musculoskeletal and the rest). Faculty members stand by to assess that the required maneuvers are performed correctly.

But all that training can be undone the moment the students hit their clinical years. Then, they discover that the currency on the ward seems to be “throughput”  getting tests ordered and getting results, having procedures like colonoscopies done expeditiously, calling in specialists, arranging discharge. And the engine for all of that, indeed the place where the dialogue between doctors and nurses takes place, is the computer.

The consequence of losing both faith and skill in examining the body is that we miss simple things, and we order more tests and subject people to the dangers of radiation unnecessarily. Just a few weeks ago, I heard of a patient who arrived in an E.R. in extremis with seizures and breathing difficulties. After being stabilized and put on a breathing machine, she was taken for a CT scan of the chest, to rule out blood clots to the lung; but when the radiologist looked at the results, she turned out to have tumors in both breasts, along with the secondary spread of cancer all over the body.

In retrospect, though, her cancer should have been discovered long before the radiologist found it; before the emergency, the patient had been seen several times and at different places, for symptoms that were probably related to the cancer. I got to see the CT scan: the tumor masses in each breast were likely visible to the naked eye  and certainly to the hand. Yet they had never been noted.

Too frequently, I hear of (and in a study we are conducting, I am collecting) stories like that from all across the country. They represent a type of error that stems from not making use of basic bedside skills, not asking the patient to fully disrobe. It is a more subtle kind of error than operating on the wrong limb; indeed, this sort of mistake is not always recognized, and yet the consequences can be grave.

IN my experience, being skilled at examining the body has a salutary effect beyond finding important clues that lead to an early diagnosis. It is a ritual that remains important to the patient. Recently my ward team admitted an elderly woman who had been transferred from her nursing home in the night because of a change in her mental status. A CT of the head and all other tests were determined to be normal; the problem had been dehydration, and she was better, ready to go back. But as our team was about to enter the room, my intern warned me that the patient’s lawyer daughter was unhappy with the plan to return her mother to the nursing home, and was waiting impatiently to see me and contest the transfer.