The New York Times published an excellent article on how doctors have neglected learning or practising one of the most important aspects of their art – the physical examination.
The fact that many doctors order sophisticated tests without examining their patients properly is no less than a tragedy for medicine. There will never be any machine that can diagnose as accurately as a human being trained to be a doctor.
When I was at medical school in the late 70s, we were taught that you should make about 70% of your diagnoses from talking to the patient alone. Another 20% can be made from your physical examination. Sophisticated tests could pick up another 5-10% but they were mainly there to confirm what one already thought was wrong with the patient.
Things might have changed a little since then – not because the art of talking to patients and the art of examining patients have changed that much in the last 30 years – but because tests and technology have become more sophisticated. However there can be no excuse for refraining to examine our patients and there are many vital signs that can be detected by a doctor at the bedside that are invisible to the most expensive of medical investigative machines. I was taught in no uncertain terms that: ‘If you don’t put your finger in, you put your foot in!’ and the great physician, Professor Harry Seftel advised me to ‘wallow in the secretions’ of my patients.
Let us never abdicate the responsibility of diagnosis to machines. Machines are there to help doctors – not the other way around.
Event: There will be a debate at UCL on Monday night(25th October) on This House Would Stop Funding Homeopathy on the NHS This is the second one they have had on exactly this subject. Details can be seen here. The speakers announced are both pharmocologists. Am I alone in thinking it odd that a clearly political debate will be discussed by pharmocologists? If UCL debated: This House Would Abolish The Royal Family, would it be appropriate to have two professors of genetics arguing whether the superiority of the Royal chromosomes justify the amount of taxpayers’ money spent on the Royal Family? To be fair, I was invited to speak at this debate (with 4 days notice!) but was advised to decline on this occasion because of the ridiculously short notice given to me. I’ll come along anyway though and perhaps say something from the floor if invited to do so. Why not come along yourself and watch how pharmacologists debate an issue that is essentially about liberty and democracy?
Meanwhile Ed and Liz continue their conversation about Homeopathy, the NHS, Science, Scientism and Democracy.