It seems easier being retired from clinical practice and living outside the United States to see big-picture changes in our specialty. I recently read Dr. Shari Welch’s “Death of the Physical Exam” article. She is on target about the value of the ED exam in everything from chest pain to UTIs, especially her observation that a focused history “gets you 99 percent of the way” to a diagnosis. She concludes that a faux physical exam will make the patient feel better (better patient satisfaction score?).

My thoughts go in a different direction. I am reminded of a scene in the Mel Gibson movie Payback, where he extracts information from his double-crossing partner and then asks him for a match to light his cigarette. When the scumbag responds that he doesn’t have one, Mel asks, “Then what are you good for?” right before he blows him away.

I think EMDs should ask what exactly is their unique role in the brave new world of emergency medicine populated by MLPs, ever-improving diagnostic technology, protocols and pathways, clinical computer apps, etc., etc. Such introspection might help in pursuing skill sets needed going forward in their careers since clearly “the laying on of the hands” won’t be one of them.

Robert T. Fitzgerald, MD, FACEP
Nueva Gorgona, Panama