Filenews 24 August 2025 - by Dr Lakis K Anastasiades
Just before I decided to... to hang up my stethoscope and rest, I was visited by a Turkish Cypriot patient, accompanied by her daughter, from occupied Nicosia. After filling in the patient's history and detailed examination, the daughter told me in amazement: "I see, doctor, that you are still using the old traditional examination, while our doctors no longer touch the patient. They proceed directly to the referral of diagnostic tests!"
I didn't know how to interpret her comment. Was it praise for me for taking the time to examine her mother, or was she trying to point out to me that "their own doctors" had outdone us?
It is a fact that in recent years, with the evolution of medicine, the traditional medical examination, where the doctor has time for a detailed history and physical examination of the patient, has been questioned. My generation was taught that a detailed history and a thorough physical examination of the patient would give you a 90% correct diagnosis. The rest could be supplemented with additional diagnostic analyses.
With the opening of the first Medical School of the University of Nicosia in collaboration with St George's Medical School in London, I had the opportunity to be in contact with the modern teaching system and with students. Indeed, in general, the emphasis on teaching was transferred to new technologies and modern diagnostic methods. The general tendency is for students to focus on the right choice of laboratory tests, to know and evaluate the results of new methods of diagnosis and treatment, and to largely put aside physical examination.
Students have the impression that knowing the details offered by an ultrasound, a CT scan or multiple blood tests is more important, while the doctor saves time serving more patients instead of "wasting time talking and examining" the sick person!
In many medical centers abroad, the traditional "tour" of doctors no longer takes place in the beds of the sick, but in a conference room, in front of computers and screens where they have easy access to all the necessary information of the patients as well as to the images of the diagnostic tests.
Students are rightly asking: how useful is the physical examination of the patient?
Probably, our regular patients do not need a comprehensive examination every time they visit their doctor. However, it will be a mistake to omit a detailed medical history and a targeted physical examination at the first visit that will lead the doctor towards a proper further investigation of his problem. Both the doctor and the patient should know that without the detailed medical history and the methodical physical examination, the doctor will not have any direction in terms of diagnosis, And he will resort to a lot of unnecessary tests that will probably not help, but will probably do harm to the patient. It is worth noting that the main source of radiation to the public comes not from nuclear power plants, as we would reasonably assume, but from the doctors themselves, through the unnecessary radiological examinations that their patients undergo.
Recently, I was surprised to see on TV and I heard on the radio for days an advertisement-campaign, which, while aimed at informing the public about the prevention of various diseases, actually misled the public! He emphasized that, supposedly, the CT scan of the lungs is imposed as a routine examination! If possible! At a time when there is already an increase in cancers in the general population internationally, resulting from excessive, reckless and unnecessary use of these diagnostic tests that emit radiation. Of course, I hastened to point out this medical misinformation to the authorities, who seem to have acted quickly and the advertising stopped!
Undoubtedly, in most cases, with a complete history and physical examination, we can bypass many unnecessary examinations and avoid the enormous inconvenience of the patient, but also the financial burden of the GHS. A visit to the doctor is considered insufficient if the patient is not examined. Let patients keep this in mind so that they can evaluate their doctor.
But what is it that makes the examination so necessary, apart from the aforementioned in the doctor-patient relationship?
A convincing interpretation has been given by Dr. Abraham Verghese (Abraham Verghese, A doctor's touch/Video on TED.com) professor at Stanford University, USA about the doctor's touch! Dr. Varghese associates various rituals, such as marriage, graduation from university, and so on, and argues that "the physical examination of the patient is a ritual that brings our relationship with the patient very close. The patient comes to our office and reveals to us his/her most personal details and issues, which he or she may not say anywhere else. Then, not only does he accept, but he waits for the doctor to touch him, to examine his heart, lungs, abdomen and whole body. This ritual establishes our relationship with the patient, a relationship of trust and love."
Dr. Verghese describes a touching passage in the case of one of his patients who was dying of AIDS. In his last days, when his body was already skeletonized, the doctor visited him and examined him daily, even though his examination would have no effect on the patient's life. However, this ritual was purifying for the doctor and necessary for the patient. Through this ritual a very important message was passed: "I will always, always be here. I will be with you and we will go through this experience together. I will not abandon you, I will be with you until the end..."
Modern medical education distances itself from the Hippocratic view that man is a single psychosomatic entity and that clinical examination must be thorough. Aristotle was the first to establish that touch belongs to the functions of our animate body. "Without touch there is no other sense", the great Greek philosopher tells us!
Yes, the doctor should touch the patient's hand and examine him diligently in the examination bed or hospital bed. The physical examination is a touch that will bring the patient closer to the one who has entrusted his health, his life.
*Dr. Lakis K. Anastasiades is a cardiologist.
