I am fortunate to work at an institution that typically has great speakers for grand rounds. I try to make medicine grand rounds every week, but Friday mornings are hectic. Usually, I am running around trying to discharge patients or, alternatively, at home sleeping after a busy night shift. Thankfully, all the medical grand rounds are recorded, so we can go back and view them when time allows.

This is how I stumbled on the lecture of Dr. Abraham Verghese and the “Stanford 25”. When I was looking through the titles of grand rounds I had missed, I didn't immediately recognize Dr. Verghese's name, but I knew it sounded familiar. What I didn't realize was that Dr. Verghese's work is actually familiar to me in several ways. First, he is the author of several books, most notably Cutting for Stone, which is on my reading list (My list has currently been frozen while I am studying for my recertification exam.). Secondly, he is the Stanford University physician who lectures around the country on the importance of the physical exam in the patient/provider relationship and rediscovering the lost art of the physical exam. In fact, several months ago I had heard him interviewed on National Public Radio (NPR) on the importance of the physical exam and how it has become a lost art replaced by an overreliance on technology.

Dr. Verghese's grand rounds are part of the “Humanities in Medicine” series at our institution, and he cleverly made the case for the importance of the physical exam by reviewing the famous painting “The Doctor” by Sir Luke Fildes. The lecture also introduced the concept of the Stanford 25, which Dr. Verghese is a part of. The Stanford 25 is a physical exam skills course developed at Stanford University for their medical students and resident physicians. In addition to an actual course, they developed a website with 25 physical exam skills of importance. The website is meant to serve as a resource for providers looking to develop their physical exam skills or for groups looking to create their own skills course.

While Dr. Verghese's main audience for the grand rounds was physicians, I think that the concept has applicability for physician assistants, too. We are all taught in PA school how to perform a complete and detailed physical exam. As we enter practice, we tailor our exam to our specific practice, specialty, and patient volume. As Dr. Verghese pointed out during his lecture, sometimes clinicians may feel that the physical exam can take a back seat to more sophisticated diagnostic testing. I personally don't feel this way. I was fortunate to learn the importance of a good physical exam early in my career while working in an emergency room (ER) in New York City. Often diagnostic testing was not working or too backed up to be of use. My initial treatment plan was often guided by my clinical assessment, which included a good physical exam.

During the lecture Dr. Verghese also emphasized how important the physical exam is in how we develop trust with our patients. This concept really resonates with me, especially when reflecting on my past patient experiences. For example, when I worked in the ER where patient visits can be very short on a busy shift, I like to think that taking time to perform a good physical exam served as reinforcement to patients that I was taking their problem seriously. The value of a good physical exam has been further highlighted in the last few years practicing abroad, where health care resources are less and the reliance on a good physical exam is greater. Dr. Verghese's grand rounds and advocacy have provided a clear narrative for something that I always felt to be true.

Watching grand rounds and reviewing the website/material from the Stanford 25 has inspired me to improve my own physical exam skills. I will continue to review the Stanford 25, and once I am done studying for recertification, my goal is to review one physical exam skill per week until I get through all 25. On a related note, also included on my to-do list post recertification is to read Cutting for Stone, which I hear is good. Maybe a combination book review and tips on how to polish up physical exams skills will be my end-of-the-year blog. In the mean time, I recommend reviewing the Stanford 25 website, which includes not only the “25” but also physical exam resources including a blog and links to related writings and media by Dr. Verghese and his staff.

Zachary Hartsell works in hospital medicine in Phoenix, Arizona.