Percuss

Recently, weighed down by the ever-present concern about epidemic of coronavirus infection, doctors are often separated from patients by double doors. Even when doctors muster the energy to go through the doors, the patients should still be examined with gloved hands.

That's what I have been - and supposed to be - doing in the medical wards catered for patients returning from Wuhan province or Korea.

Eager to get an accurate diagnosis, we are instead relying on advanced imaging techniques or laboratory tests like real-time polymerase-chain-reaction assay. Too often, we skip the step of touching the patients.

I'll preface this by saying that I lament the loss of basic physical examination. Skipping physical examination of patients is not my thing. Not remotely. The way I see it, once you've decided to make good use of stethoscope, and if you can bring a proper one instead of improvising the primitive-as-a-toy stethoscope at bedside, there's little reason why you should have a cursory examination. You either listen properly or do not listen. Don't pretend to listen.

The same goes for percussion, another time-honoured bedside skill we have been teaching medical students. Imagine cocking your right wrist and let the right fingertips fall like piano hammers on the left fingers placed on a surface. Then pay attention to finger tapping on patient's body parts - the pitch and tactile sensation - to get the feel. The sound will be resonant on percussing a hyperexpanded chest, but appear stony dull if there is fluid pushing the lungs away.

Over the years, I have learned to appreciate the musical notes crafted by finger-tapping. It works, especially when you don't have easy access to handheld ultrasound machine wherever you go. But then, having worn latex gloves in most hospital designated areas, I am stuck. The typical features of resonant or dull percussion note simply blurred. Try as I might, I could no longer tell the difference between a hollow structure and a fluid-filled body part.

What's the quick fix? My tip: remove the gloves (and make sure the infection control officer isn't behind your back, of course).

Or so I thought.