I started making house calls or home visits on home hospice patients in 1989. This was the year that a group in our rural community opened a hospice program and they asked me, the new doctor in the county, to be the “volunteer’ Medical Director. A few months later one of our new patients was insistent that I come to see her.  I did.

This experience was an epiphany and I started making these visits routinely. I discovered that I enjoyed these visits and found the patients and families were excited to have a doctor come.  I would listen to their stories, enquire about symptoms, review the medications and …. I would lay on hands. Listen to their hearts and lungs, check for anemia, edema, skin breakdown or other assorted things. Occasionally I would find something that would change what I would do, such as taut ascites that would need a tap, or edema or signs of dehydration that would suggest a change in the “fluid pills”. 

Mostly these were intimate moments where I would touch patients .  The healing was that in that moment they were OK.  They would not have felt like the visit was complete without the physical exam. I would joke with the chaplain that my stethoscope around my neck was like her collar. They both allowed us entrance into an intimate human space.

In service of expediency and now pushed by the need to do more by video and virtual visits, the physical exam is under attack.  Can you prove that those minutes you spent examining and documenting the exam changed the outcome for patients? And if not, then why do a physical exam?  How do you “measure” a ritual that brings peace, closeness, and intimacy between patients and their providers?.   I am on a mission to identify the Patient Reported Outcome (PRO) that relates to the physical exam. It is our only hope to save this precious ritual.

Read more about the attack on the physical exam at

The Disappearance of the Primary Care Physical Examination—Losing Touch https://ja.ma/2TQ4Cva