So many arguments about what's wrong with medicine today are predicated on imagined (and inaccurate) histories. Let's take some examples from my colleagues who imagine a "golden" age of the exam:
The physical exam is barely older than modern diagnostic tests. For example, the neurological exam was developed in the 1890s, the same time as the x-ray. We were ALREADY performing blood spears and gram stains and checking hematocrits when the neurological exam was developed.
Nineteenth century physicians didn't even see a difference between performing an exam and other tests; they were all the same to them! There's wonderful language describing increased white blood cells on a smear in the same way you describe exam findings!
Patients who presented in the wards of the "greats" had end stage tuberculosis, lung cancer, and horrible consolidative pneumonias. If you read descriptions of patients from, say, Laennec -- no wonder you could hear wonderful rales -- half their lung was scarred down with TB!
Physicians did not perform exams on their hospitalized patients every day -- they didn't even see them everyday! Yes, even William Osler, though he did lavish attention on his wealthy patients who paid him 10s of thousands of dollars in today's money.
And historically, the physical exam has NOT been a way to connect with patients -- in fact, there's historiography suggesting that its use was the ERASE the importance of the patient's perspective in their own disease (pubmed.ncbi.nlm.nih.gov/19433521/)
The "ancient" and "sacred" exam that we imagine Hippocrates, Avicenna, Vesalius, Laennec, and Osler all performed lovingly on their patients before us moderns got distracted by alienating technology NEVER EXISTED. It's a 20th century nostalgia, not based on historiography
And to all the trainees out there -- be very skeptical when anyone makes arguments about "the good old days," including the exam.
The reason that we do ANYTHING in medicine needs to be based on reasoning based on the medical conditions and realities of today -- and not imagined histories of the past.
I also wrote a thread of reading recommendations if you want to explore this historiography (and perspective) more for yourself:
https://twitter.com/AdamRodmanMD/status/1591973795971358721
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