The Stanford 25
I don’t know if anyone has heard of the Stanford 25. It is a set of 25 basic physical examinations that every doctor should know according to the team of doctors of the Stanford 25. Dr. Verghese, the senior associate chairman for the theory and practice of medicine at Stanford University and the lead doctor of the Stanford 25 is on a mission to bring back the physical exam. Medical students have learned them in school but little emphasis was placed on these skills especially in the 3rd
years of medical school or in an internal medicine residency. He and his team are out to save the physical exam because too many doctors have let the exam go and depend solely on CT, ultrasound, MRI and countless lab tests. “He still believes a thorough exam can yield vital information and help doctors figure out which tests to order and which to skip — surely a worthwhile goal as the United States struggles to control health care costs, he said”1
. He emphasized the 25 are not the only exams or even the most important ones; but they are a good place to start. Some of the exams are includes thyroid, knee, shoulder, lymph node, cerebellar, fundoscopic, pulmonary exams, spleen and liver palpitation, gait abnormalities, deep tendon reflexes to name a few.
Fortunately, naturopathic and allopathic medical students share the same education in physical exam. When a patient goes to our teaching clinic, it usually takes three appointments before the student clinician could formulate a treatment plan. The first appointment involves a thorough intake of the chief complaints, patient’s health history and pertinent information. The second intake is an hour long physical examination and then the clinician will discuss the treatment plan in the third appointment with the patient. Hopefully, when we are out on our own, it won’t take one hour to go through the physical exam and three appointments to formulate a treatment plan; however many of the naturopathic doctors I know still employ a physical exam as part of the first intake.
It is nice to hear that conventional doctors are focusing more on the hands-on exams. At our school, our instructors always emphasize the importance of physical examinations and/or physical modality such as massage, acupuncture, manipulation because it is very important for the patient to feel the touch and connection. A proper exam also earns trust; it is a ritual that transforms two strangers into doctor and patient as Dr. Verghese stated. I couldn’t agree more.
1. The New York Times website: click here