The Physical Exam and the Doctor-Patient Relationship

Rene Laennec- inventor of the stethoscope

and master of the physical examination

Here is a brilliant article on the physical exam and its transformative role in the doctor-patient relationship, published recently in the Annals of Internal Medicine.


For many physicians, the physical exam is falling by the wayside, in favor of technology and diagnostic imaging.  The authors argue that patients expect some form of bedside evaluation when visiting a physician. When physicians complete the physical exam in an expert manner, it may have an important, beneficial effect. If done poorly or not at all, it can undermine the physician-patient relationship. 


Perhaps the goal should be to recognizing the importance of the bedside evaluation as both a healing ritual and a powerful diagnostic tool, especially when paired with selective use of technology. 


That would be good medicine.

Drinking Games in Medical School

If one thinks that drinking games are a thing of college parties only, then think again. Here is a paper that reports on drinking games and harassment in Japanese medical schools.

A multi-institutional survey was completed across seven medical schools in Japan. A self-report anonymous questionnaire was distributed to 1152 medical students and the response rate was high ( 951 respondents [82.6%]). The  following types of alcohol-related harassment among medical students by senior medical students or doctors: (i) being coerced into drinking alcohol; (ii) being compelled to drink an alcoholic beverage all at once (the ikki drinking game); (iii) being deliberately forced to drink until unconscious, and (iv) being subjected to verbal abuse, physical abuse or sexual harassment in relation to alcohol. The prevalence of becoming a harasser among medical students was also measured.

An astounding 821 respondents (86.3%) experienced alcohol-related harassment and 686 (72.1%) had harassed others.  In multivariate regression, having an experience of alcohol-related harassment correlated with both being harassed (odds ratio [OR] 14.22, 95% confidence interval [CI] 8.73-23.98) and being a harasser (OR 13.19, 95% CI 8.05-22.34). The presence of senior members of medical college clubs who were regular drinkers also correlated with both being harassed (OR 2.96, 95% CI 1.88-4.67) and being a harasser (OR 2.97, 95% CI 2.06-4.27).

Heavy drinking and associated harassment is common among Japanese medical students. What impact  this may have on depression, burnout and even alcoholism is unknown.

MRSA at the Dentist

We frequently associate MRSA with hospital settings. What about dental offices?


A recent study in the American Journal of Infection Control reports MRSA carriage by dental students and frequently touched dental clinic surfaces.


Sixty-one dental students and 95 environmental surfaces from 7 clinics were sampled.Thirteen (21%) dental students and 8 (8.4%) surfaces were MRSA positive. The MRSA-positive samples were from 4 of 7 dental clinics.  The 21% of MRSA carriage by dental students  is > 10 times higher than the general public and twice as frequent as in other university students. 


Hopefully, this will not deter you from going to the dentist.

VCU Watts Research Symposium- Gabriela Halder

Congratulations to VCU medical student standout, Gabriela Halder, for her Honduras research presentation today at the VCU Watts Research Symposium.


Gaby will present her work next month at the American Public Health Association annual meeting.


We are proud of her accomplishment as part of our research team.

With Mike Stevens and Gabriela Halder, VCU Medical Campus

Gabriela Halder

VCU Watts Research Symposium- Kate Pearson

Once again, Kate Pearson, making us proud, this time presenting her Honduras research at the VCU Watts Research Symposium.  The manuscript will be submitted soon for publication. 

Stay tuned.

With Mike Stevens and Kate Pearson on the VCU Medical Campus

Kate Pearson's poster at poster board #1

Mobile Phones and Mobile Bacteria

A recent British study reported that 1 on 6 mobile phones is fecally contaminated (E.coli). The authors suggest that poor hand hygiene is the culprit. I am inclined to agree. No doubt that similar bacteria is found on other high touch items like computer keyboards or remote controls.


But why should we be surprised? People are notoriously poor at washing their hands. 


I have seen many people leave the bathroom without performing hand hygiene. In one crowded airport bathroom, I overheard a gentleman chatting on the phone while in the toilet booth.  The phone and bacteria were in close proximity indeed.

Doctor and Patient or Provider and Consumer?

Source: WSJ

This is a growing controversy in medicine. Are we still doctor-patient or are we now provider-consumer?


I really hope that the latter is not acquiring permanency. Of course, there is a business side to medicine, even in a large academic center. But, let's be honest, medical encounters are rarely, if ever, a simple business transaction like buying a car or shopping for groceries. A person's well being is at stake, many encounters are urgent or under emergency situations, frequently there are few (no) options in choosing a doctor, and the cost, typically, is borne by a third party (insurance). 


This is no simple seller-buyer deal occurring in the free market.


For more, check out this perspective in the Wall Street Journal.