The Physical Examination as Ritual: Social Sciences and Embodiment in the Context of the Physical Examination

https://doi.org/10.1016/j.mcna.2017.12.004Get rights and content

Section snippets

Key points

  • The privilege of examining a patient is a skill of value beyond its diagnostic utility.

  • A thorough physical examination is an important ritual that benefits both patients and physicians; it helps to satisfy a patient’s elemental need to be cared for, and a physician’s need to make work meaningful.

  • The concept of embodiment helps one understand how illness and pain further define and shape the lived experiences of individuals in the context of their race, gender, sexuality, and socioeconomic

The physical examination in medicine and the social sciences

In a 2016 literature review of the physical examination and the physician-patient relationship, Iida and Nishigori identified 1447 studies focused on the physical examination in both the medical and social science databases, selecting 205 studies for further review.3 They found that although most of the medical literature they reviewed valued the physical examination as a means of building and maintaining the patient-physician relationship, these positive assessments were largely based on

Embodiment

In the 1980s, the concept of embodiment became central to anthropological studies that examined the ways ideologies around sex, gender, and racial differences reinforced systems of oppression in society.11 The anthropological notion of embodiment rejects the mind/body binary and instead suggests that bodies—and what people think about their bodies—is contingent upon history, culture, and a politics of power. Within this framework, each person’s body is situated not only within the story of that

The ritual of the physical examination

A ritual typically signifies a rite of passage, the crossing of a threshold, or a sacred event that is marked in contrast to events that are either quotidian or profane. For decades, anthropologists have identified codes of practice that mark rituals as transformative or timeless.9, 14, 15, 16, 17, 18 Rituals such as baptism or marriage signify both a sacred event, and a transition in one’s social status. So too does the physical examination mark a highly ritualized event. Similarly, a physical

The placebo effect and the physical examination

Studies of placebo—Latin for “I shall please”—have yielded interesting results in pain-drug clinical trials in the last 20 years. In 1996, 27% of patients reported pain reduction from a new drug compared with placebo, but in 2013, that number dropped to only 9%, and not because the drugs were less effective, but because the placebo effect is growing rapidly in the United States.21 Furthermore, studies of placebo show that it is not just a pill that can have a positive effect; “different social

Joy in practice and meaning in the examination

Physician burnout is at an all-time high, reaching epidemic proportions as a result of a changing health care system marked by financial pressures, an increased expectation in productivity, the intensified clerical burden required to manage electronic health records (EHR), and new regulatory requirements and levels of scrutiny.28, 29 This has led to a reduction in meaningful time physicians spend with patients. In order to find increased joy in practice, physicians need to feel that the work

Summary

The privilege of examining a patient is a skill of value beyond its diagnostic utility. At a time when technology and advances in medicine paradoxically threaten these simple skills, it is important to continue dialogue and research on the value of the focused physical examination. In addition, the aspects of the examination that transcend the usual medical focus—embodiment, identity, power dynamics, symbolism of locating the disease on the body as opposed to on an image or a pathology

First page preview

First page preview
Click to open first page preview

References (30)

  • D.G. Finniss et al.

    Biological, clinical, and ethical advances of placebo effects

    Lancet

    (2010)
  • A. Verghese et al.

    Bedside exam: ritual and reason

    Ann Intern Med

    (2011)
  • Improving diagnosis in health care

    (2015)
  • J. Iida et al.

    Physical examination and the physician-patient relationship: a literature review

    (2016)
  • Grace K, Salvatier J, Dafoe A, et al. When will AI exceed human performance? Evidence from AI experts. 2017. Available...
  • M. O’Rourke

    Doctor’s tell all—and it’s bad

    The Atlantic

    (2014)
  • S. Jauhar

    Doctored: the disillusionment of an American physician

    (2014)
  • B.H. Lerner

    The good doctor: a father, a son, and the evolution of medical ethics

    (2015)
  • C. Kenney et al.

    The doctor crisis

    (2014)
  • A. Gawande

    Being mortal

    (2014)
  • M. Foucault

    Truth and Power

  • N. Jones

    BIOETHICS: embodied ethics: from the body as specimen and spectacle to the body as patient

  • N.L. Jones

    Embodied Ethics: From the Body as Specimen and Spectacle to the Body as Patient

  • V. Turner

    The ritual process: structure and anti-structure

    (1969)
  • Cited by (0)

    Disclosure Statement: Neither author has any relationship with a commercial company that has a direct financial interest in subject matter or materials discussed in article or with a company making a product.

    View full text