I want to see you in the buff.

It’s true. I’m not a creep, it’s for your own good. Presumably you’ve sought out my professional services because of an injury or you’re sick. You make your way to an examination room. A medical assistant has handed you a gown with verbal instructions to put the opening in the back and told you it’s okay to keep your underwear on. Then he closed the door to assure your privacy.

Several minutes later I’m bedside ready to perform a focused history and physical exam. But you’re still fully dressed?! What the heck? It’s not just that you’re wasting my time. (You are.) Our relationship needs appropriate input from both sides. You give me the information I need and I, considering the information you provide, make the best possible diagnosis. But it’s not just your history, it’s also the clinical information gleamed from your examination that is critical to making an accurate diagnosis.

Medical providers know that when we chart “WNL” it means “we never looked”, and over 25 years I’ve seen countless examples of a missed or near-missed diagnosis due to limited physical examination. Just for example, consider an ER cardiac chest pain work-up that later was discovered to be caused by shingles, the “atraumatic” low back pain that ended up being a stab wound and the post-MVA “my insurance guy said I should get checked out” with 6 broken ribs.

None of these diagnoses would have been possible without demanding that the patient, despite their objections, disrobe for complete examination. I feel so strongly about this for fear of missing something critical that I often have objectors to disrobing sign an AMA form assuming personal responsibility for a missed diagnosis.

If nothing else, putting on that gown allows for expeditious and complete examination and reduces the risk of you being discharged with a stab wound.