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In medicine, observing the surface is far from superficial

Medical innovations have made examining health from the inside out easier and easier. But, as Stanford's Abraham Verghese, MD, comments in a recent New York Times article on the aging face, the in-person physical exam can be equally revealing to those well-trained in observation:

[Dr. Verghese] ran through a list of facial changes that can be tip-offs to ill health, and that doctors can pick up at a glance: a sparseness or absence of the outer third of the eyebrows can signal thyroid failure; a moon-shaped face may mean a person is taking steroids; a “laugh line” deeper on one side of the face than the other may indicate a previous stroke or other facial paralysis; a very broad forehead and large nose may signal acromegaly, a dangerous condition caused by too much growth hormone.

Verghese goes on to say that he can identify gout by examining patients' ears and can tell if patients have had cataract surgery based on the glint of their eyes. The art of doctor-patient communication is a subtle one, and Verghese's comments are a reminder that stepping back and taking a moment to observe a patient face-to-face can be just as important as peering inside.

Previously: Exploring the “fading art” of the physical exam, The power of touch in the exam room and Hands on: Abraham Verghese teaches bedside skills

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