Wednesday, September 09, 2009

Mourning the loss of basic clinical skills

In his recent essay in the Texas Heart Institute Journal Herbert L. Fred, MD points out another cause of excessive medical costs: the loss of basic clinical skills.

For nearly 4 decades now, I have watched with sorrow the progressive demise of bedside medicine. Admittedly, the advent of ultrasonography, echocardiography, computed tomography (CT), and magnetic resonance imaging has enabled us to establish diagnoses with speed, accuracy, and safety never before imagined. At the same time, however, overreliance on these technologic marvels has crippled physicians' use of the mind and the 5 sensory faculties to make diagnoses. Jumping from the patient's chief complaint to a host of tests and procedures has become virtually routine. And when that approach fails, the physician typically orders more tests and seeks numerous consultations.

This new way of practicing medicine has made the skilled clinical diagnostician a vanishing species, a true “dinosaur.” It has also taken most of the fun and challenge out of medicine. It has depersonalized the patient–doctor relationship and has essentially eliminated the individuality of patient care. I call this malady of practice “technologic tenesmus”: the uncontrollable urge to rely on the lastest medical gadgetry for diagnoses.

The article is well worth reading in its entirety.

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