Palpation — The Forgotten Tool of Medical Diagnosis

Today’s med­ical tech­nol­o­gy is absolute­ly fan­tas­tic.  New diag­nos­tic devices are invent­ed almost as fast as we can imag­ine them.

Medical-Technology

A hun­dred fifty years ago, the only tool a doc­tor had to test your heart was his (or her) ear.  Doc­tors of the day could detect basic abnor­mal­i­ties of the heart’s rate, rhythm, or strength.  Now, with echocar­dio­grams and even more advanced meth­ods, we can dif­fer­en­ti­ate a sub­tle range of car­diac prob­lems that was unimag­in­able in the mid-1800’s.

 

Back in those old days, a doc­tor also used her eyes to gath­er diag­nos­tic infor­ma­tion.  If she were around today, she’d be in awe of the gad­getry that’s super­seded the human eye.  Here’s one tee­ny exam­ple:  a cam­era so small (the endo­scope) it can slith­er through the stom­ach and into your intestines to pic­ture what’s going on there.

Years ago, doc­tors smelled and tast­ed your urine to diag­nose prob­lems.  (Sure it sounds weird, but it’s true – in fact, a taste of urine is still a diag­nos­tic essen­tial in parts of the world.)  With this rough test­ing method the doc­tors of yore could deter­mine if there was sug­ar in your urine – a sure sign of dia­betes.  Maybe they could guess at a cou­ple of oth­er dis­eases too.  But now we have chem­istry lab­o­ra­to­ries that can detect a few parts per bil­lion of hun­dreds of dif­fer­ent chem­i­cals in your urine.

Our med­ical tech­nol­o­gy is so advanced, that for diag­nos­tic pur­pos­es four of our basic sens­es – sight, sound, smell, and taste – are near­ly obso­lete.

But what about the fifth sense – touch?

With the sense of touch the sto­ry is entire­ly dif­fer­ent.  The per­cep­tu­al sophis­ti­ca­tion of the human hand is still way, way ahead of any engi­neer­ing wiz­ardry.

seated lumbar palpation

The human hand can detect a remark­able range and sub­tle­ty of

  • warmth
  • tex­ture
  • mois­ture, and
  • elec­tri­cal and mag­net­ic field strength.

Unlike see­ing or hear­ing, the use of touch is active – the mus­cles of the arm and shoul­der delib­er­ate­ly engage the hand in its encounter with a patient’s bod­i­ly tis­sues.  That means the hand can also detect

  • the tight­ness or pli­a­bil­i­ty of mus­cles, lig­a­ments, joints, nerve sheaths, and oth­er struc­tures, and
  • the resis­tance to move­ment or ease of flow of these tis­sues.

Touch can also give infor­ma­tion about

  • the enlarge­ment, atro­phy, or swelling of inter­nal organs
  • the blood flow to an area, and
  • the pres­ence of ten­der­ness, tin­gling, or numb­ness.

Of course, the advanced skill of an expert in pal­pa­tion goes way beyond rou­tine, untrained touch.

To gather diagnostic information through the sense of touch — that’s the definition of palpate.

Pal­pa­tion is the one irre­place­able diag­nos­tic skill all doc­tors should mas­ter.

Except they don’t.

Although they’re exposed to the con­cept of pal­pa­tion in med­ical school, most doc­tors nev­er take the prac­tice time to advance beyond a kinder­garten lev­el of mas­tery.

Why?

Here are a few pos­si­ble rea­sons:

  • Doc­tors make extra mon­ey with fanci­er, high­er-tech (though not nec­es­sar­i­ly more mean­ing­ful) diag­nos­tic tests.
  • The use of high-tech meth­ods gives the illu­sion of greater exper­tise and cur­rent sci­en­tif­ic know-how.
  • Doc­tors strate­gize to keep per­son­al patient inter­ac­tion to a min­i­mum, and are more com­fort­able sit­ting behind a desk and writ­ing pre­scrip­tions.
  • Pal­pa­tion takes time – with today’s insur­ance-dic­tat­ed reim­burse­ment, actu­al­ly touch­ing a patient takes too long.

What­ev­er the rea­sons, the result is poor­er patient care at a much high­er cost.  The lim­it­ed use of pal­pa­tion is one rea­son Amer­i­cans receive sub­stan­dard care at inflat­ed prices.

Trag­i­cal­ly, pal­pa­tion has been all but aban­doned – except by one group of doc­tors.  Doc­tors of Chi­ro­prac­tic.

Because of their advanced train­ing and dai­ly use of the art of pal­pa­tion, doc­tors of chi­ro­prac­tic are often able to arrive at a more mean­ing­ful diag­no­sis of your prob­lem with­out being seduced by the results of fan­cy test results.

You deserve the best of both worlds.  At times, that could mean tak­ing advan­tage of the lat­est mar­vel of med­ical tech­nol­o­gy.  But it also might mean hav­ing con­fi­dence in the high­ly devel­oped exper­tise of a physi­cian rely­ing on an ancient method – the heal­ing pow­er of the skilled human hand.

 

 

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About Ronald Lavine, D.C.

Dr. Lavine has more than thirty years' experience helping patients alleviate pain and restore health using diverse, scientifically-based manual therapy and therapeutic exercise and alignment methods.

His website, askdrlavine.com, provides more information about his approach.

Please contact him at drlavine@yourbodyofknowledge.com or at 212-400-9663.

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