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  If she were around today, she’d be in awe of the gadgetry that’s superseded the human eye.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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