Passé or a time to pause? A phenomenological study of family physicians’ experiences of physical examination

BackgroundOnce the cornerstone of clinical family practice, the role of physical examination is changing. Patients and physicians alike express concern that emphasis on evidence-based medicine and increasing reliance of technology has relegated the role of physical examination in clinical practice.AimTo understand the role of physical examination in contemporary family practice.MethodQualitative phenomenological study, interpreted through the writings of Merleau-Ponty. Semi-structured interviews were conducted with a purposive sample of sixteen family physicians; men, women, recent graduates and experienced physician working in urban, rural and academic practices. Interviews were recorded, transcribed and examined using template analysis, complimented with researcher reflexivity.ResultsStudy participants described physical examination as core to practice, to diagnose, to communicate, and to validate patient and practitioner concerns. Performance of physical examination became routine over time but a disruption to the expected caused physicians to pause. Participants described this as a slowing of time where they became conscious of the body of the patient and their own body, intertwined in a moment. Physicians experienced affective, intellectual, and physical phenomena, which integrated to guide their behaviour, diagnosis, and management of the patient. The role of physical examination was to not only diagnosis as an evidence-based medical expert, but was experienced as a form of embodied, nonverbal communication, which expressed care.ConclusionPhysical examination plays an important role to reassure and communicate trust in the doctor–patient relationship, enacted through the body of the physician. Complimenting diagnosis, the laying on of hands remains an essential element of patient care.