pal-pat-ed, pal-pat-ing, pal-pates

To examine by feeling with hands and fingers; used by some archaic physical therapists, who (Bless their Hearts) just don’t know any better.

As many of you know, I’m currently fortunate enough to be on an APTA board tasked with developing a definition for a new Board Certification which will fall along the lines of:  Primary Care or Family Practice or Family Health (or whatever title meets consensus).    Well as we flushed out what exam skills should be included in this specialty we fleshed out a solid 2-3 paragraphs on behavioral testing and under palpation?  Nothing.  The Palpate bullet stood alone.  When I suggested it needed some description the other members of the group (all senior and experienced clinicians) didn’t show a lot of excitement to elaborate on the “palpation” bullet.

A little about me….my exam is MOSTLY palpation…the more experienced I become as a clinician the MORE I rely on palpation.  I was an Army Physical Therapist for 20 years and I was awarded the Surgeon General’s award for clinical expertise.  In one year of a cash-based clinical practice with 0$ spent on advertising I had a 4-week waiting list.  I’m only mentioning this to underscore that I must be doing something right as a clinician and palpation is the cornerstone of my practice.

I always tell my students that “your eyes can be fooled, your ears misled, but your hands will perceive a true reflection of what is happening in your patient’s body.”  If my clinical experience has any validity to it at all…and I’m inclined to believe it does based on my patient success rate…then why has the profession of physical therapy turned away from palpation?  I feel that as the pendulum has swung towards Evidence Based Practice, it has at the same time swung away from Intuition and Feeling of which palpation is a tool.  Our research based institutions have a hard time “measuring” palpation for validity or reliability and so it’s been shunned to a great extent.

I’m not arrogant or foolish enough to think that the ramblings of an “old” clinician will affect any change of teaching in any physical therapy program, I’m just mentioning it here to plant the seed for younger clinicians.  These younger clinicians who at some point in their career may become “burned out” or disillusioned with their profession because patient after patient just doesn’t seem to be making spectacular improvement in spite of following the Clinical Practice Guidelines to the letter.  I’d advise these younger clinicians to take a moment…close their eyes, screen their ears, turn ON their intuition and really “feel” what their hands and fingers are palpating.