The pause: experiencing abnormal in the physical examination, a phenomenological study
Location
1049
Format Type
Event
Start Date
January 2018
End Date
January 2018
Abstract
Physical examination is an inherent part of medical practice. The patient’s body is typically examined as an objective field of scrutiny. Yet, there is growing recognition of the subjective nature of physical examination, with an emphasis on patients’ experiences. The physician’s body remains relatively absent. In this study, we explored the lived experience of physical examination by the physician.
This was an interpretative phenomenological study, set in family medicine. Physicians of varying backgrounds detailed their experiences of physical examination. Interviews were recorded, transcribed, and field notes recorded. Data were analyzed using template analysis, reflective writing and a dialectic movement between transcripts and emerging interpretations, paying explicit attention to how prejudgments informed our analysis.
Sixteen family doctors participated, 8 women. Five participants worked in rural practice; 5 were recent graduates. Physical examination was an automatic routine but a disruption to the expected caused physicians to pause. Fingers stalled. The physician heard her own heart beat, slowed her breathing, became sensitive to sweat and sound. Participants described suspended seconds, where through fingers, breath and eyes, the absent body became palpable. They became conscious of the body of their own body, in relation to that of the patient, intertwined in a moment.
We examined these findings using Merleau-Ponty’s ideas of subject-body and chiasma. Through habits of practice, participants developed body schema enacted pre-reflectively. Encountering the unexpected disrupts the habitual body, and brings body and time to the fore. Physical examination becomes an intersubjective, embodied exchange between patient and physician.
The pause: experiencing abnormal in the physical examination, a phenomenological study
1049
Physical examination is an inherent part of medical practice. The patient’s body is typically examined as an objective field of scrutiny. Yet, there is growing recognition of the subjective nature of physical examination, with an emphasis on patients’ experiences. The physician’s body remains relatively absent. In this study, we explored the lived experience of physical examination by the physician.
This was an interpretative phenomenological study, set in family medicine. Physicians of varying backgrounds detailed their experiences of physical examination. Interviews were recorded, transcribed, and field notes recorded. Data were analyzed using template analysis, reflective writing and a dialectic movement between transcripts and emerging interpretations, paying explicit attention to how prejudgments informed our analysis.
Sixteen family doctors participated, 8 women. Five participants worked in rural practice; 5 were recent graduates. Physical examination was an automatic routine but a disruption to the expected caused physicians to pause. Fingers stalled. The physician heard her own heart beat, slowed her breathing, became sensitive to sweat and sound. Participants described suspended seconds, where through fingers, breath and eyes, the absent body became palpable. They became conscious of the body of their own body, in relation to that of the patient, intertwined in a moment.
We examined these findings using Merleau-Ponty’s ideas of subject-body and chiasma. Through habits of practice, participants developed body schema enacted pre-reflectively. Encountering the unexpected disrupts the habitual body, and brings body and time to the fore. Physical examination becomes an intersubjective, embodied exchange between patient and physician.
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