P1013 - Physician perspective on utilizing guided parental exam to augment diagnostic reasoning

Physician perspective on utilizing guided parental physical exam during Telehealth encounters

Background

Telehealth has become a vital medium in maintaining the patient-physician relationship in recent months. Practices and health systems have accepted Telehealth with open arms in almost all specialties' including primary care. Many physicians do not have the experience of using guided physical exams during Telehealth, particularly in pediatrics. This is much more vital when parents give a limited history, and children are not able to vocalize symptoms well. This study aims to assess the physicians' perspective on utilizing guided parental/guardian exams to improve diagnostic reasoning.

Methods

We surveyed Pediatricians (n=18) from four primary care practices in an academic practice setting. 12/18 (66%) of the providers responded to the survey. The survey questions assessed current practices of physicians in utilizing parental exam and asked them to rank from a list of possible physical exam items from each system they are confident of having a guided parental exam.

Results

Six physicians (50%) stated they always have parents do guided physical exam, and the rest (50%) said they may or may not depending on the clinical situation. A majority of physicians, 10/12 (83%), documented the findings in the physical exam component of the chart. 90% (11/12) of the physicians strongly agreed or agreed that having a parent or guardian perform physical exam improved their diagnostic reasoning. Mental health concerns, ADHD, ear pain, rash, URI, conjunctivitis, pharyngitis, asthma, abdominal pain, headaches, musculoskeletal pain were some of the typical patient problems encountered.

Physicians were confident in parental ability to perform the following: checking pulse and respiratory rate, confirming conjunctival and scleral injection, pharyngeal erythema and exudates, checking for thrush/ulcers in the mouth, palpating for frontal and maxillary sinus tenderness, cervical lymph node swelling, assessing chest wall retractions and tenderness, assessing abdominal distension, palpating for abdomen and CVA tenderness and describing rash texture by feeling. 9/12 (66%) physicians were confident in having parents check for muscle strength of upper and lower extremities, CN III, IV and VI, XI, and coordination. Physicians were not comfortable in asking parents to perform exams such as a sensory exam, Kernig, and brudzinski signs as well as specialized musculoskeletal exams such as straight leg test, valgus, varus stress test, and joint tenderness.

Conclusion:

As the landscape of Telehealth continues to change, pediatricians and family physicians need to be more aware of utilizing parental/guardian guided physical exam as a tool for Telehealth. A specific parental resource such as YouTube videos, which demonstrate guided physical exams, may need to be considered to help both parents and physicians navigate the complex nature of Telehealth physical exams, which will be a valuable tool to augment diagnostic reasoning.