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The Lost Art of Medicine?

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.

By | 2010-10-23T10:44:18+00:00 October 23rd, 2010|Current Affairs, Homeopathy, Video|14 Comments

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14 Comments

  1. skepticat October 23, 2010 at 2:22 pm

    That’s a rather cruel stereotype of a homeopathist. They’re not all as stupid and petulant as Elizabeth.

    By the way, where does the $10 million figure come from? Has somebody in real life claimed that figure.

    • Dr. Kaplan October 23, 2010 at 3:54 pm

      Hi Skeptickat, These figures are not in dispute. Of course it’s 10 million pounds sterling. That is the bill for homeopathic medicines paid for by the NHS. It doesn’t include hospitals and doctors etc but it is still 0.1% of the total bill for NHS medicines. That is why the assertion that NHS homeopathy is a waste of money has been
      given a hugely disproportionate amount of attention in the media. Antidepressant SSRI tablets are FAR from being fully evidence based, yet the NHS budget for them is 232 million pounds!.And whenever I mention them I am accused of indulging in a strawman argument. Double standards? You betcha!!
      Btw all the figures cited in the cartoon are in the public domain. Someone I know researched them and they can be seen here. Look at the link in the last paragraph.

  2. Guy Chapman October 23, 2010 at 4:14 pm

    I think it would be perfectly fair for homeopathy to receive a 30C dilution of NHS funding. That 10^-47p, more than it’s worth but it wouldn’t be missed.

    • Dr. Kaplan October 23, 2010 at 4:32 pm

      @guy chapman: That sort of joke has been made for about 200 years. What you don’t understand is that politics needs to answer to the people
      not to the personal feelings of the disciples of scientism.

  3. Sastry.M October 26, 2010 at 7:15 pm

    Dr.Brian Kaplan- Art qulifies a state of perfection in any field of human application and is attainable only with true understanding of all subtle aspects and dedicated practice be it painting,sculpture,music, medicine etc. Until the middle of 19’th century when rapid industrial growth began taking shape art was still appealing to human heart with its finer aspects inspring nobility of mind. With the consequence of progressive scientific knowledge subtle ideas began actualising through technological innovations into instrumental contraptions finally leading to engineering practices of mass industrial production. Thus arrived a synthetic mechanical civilzation when human hearts began leaving appeal to art of nobility and shifting to worth based values of utility defined with negotiable instruments of transactional business and circulating paper currency. This tempo infiltrated into all aspects of human existence including supportive medicine placing desire promoting business of utilitarean values above humane considerations of noble empathy even selling works of art to display as superficial status symbols of possessive self aggrandizement and with no real artstic appreciation.

  4. Fritz Kabongo MD October 27, 2010 at 3:57 am

    Doc,

    More money is wasted on ‘orthodox’ crap that can cause harm. Homeopathy is safe. It has stood the test of time.

    Since I am an American, you know my take: MONEY!
    As mentioned before, these homeopathic remedies could easily bump up income by significant amounts.
    Health Care is a euphemism for Health Business. Doctors strive to become successful money-making machines, or even the more generous cash-dispenser archetypes.
    Life is short, and as such, it must be highly profitable. Homeopathy provides this added option.

    Some of my friends practice anti-aging medicine and you should see the dangerous crap rolling around there! Some perform unnecessary surgeries, such as fusion for back pain (not proven to work, in the vast majority of cases).

    As for physical examination, I do agree that it is good medical practice. However, we abandoned that over here, which is why we are proud to be ranked 37th in world for quality of care. However, our incomes are among the highest.
    The tests we order make money! The business WINS!
    They also pick up things on which we can do more tests. Tests=money. Physical exams pay bupkes, although many doctors are speaking about charging extra for this ‘menu item’.

    Sastry makes good philosophical arguments, in a way.
    We live in a society where humane considerations are subjugated by mercantile imperatives. That is pragmatic realism (including practicing in such a way that avoids lawsuits; tests accomplish this, too).

    In the end, USA! USA! does provide the best medicine that money can buy, so you can get the best…if you elevate yourself to being rich…almost.

    Warm Regards,
    Fritz Kabongo MD

  5. Sastry.M October 28, 2010 at 9:29 am

    @Dr.Fritz Kabango,
    Thanks to you for my philosophical reference. Being an Indian having a narrow waist and thin wallet philosophy is the only solace and Homeopathy is the only best alternative medical support appealing to both. If we recall historic development of homeopathy USA remained the second home as the promised land of migrating Europeans during 19’th century and truly pioneering the development of homeopathy even far surpassing that at far off homes. The present situation is explained with your apt narration and the key to hope and towering homeopathy to success still lies with the USA in spite of fallen mercantile towers of international trading.
    sincerely,
    Sastry.M

  6. Fritz Kabongo October 29, 2010 at 12:43 am

    Hi Sastry,

    You make some good observations about The Land Of Plenty. My neighbor is a homeopath and he drives a Maserati.

    Homeopaths are totally free to roam the range over here. As said before, this approach to medicine, while not readily and rigidly evidence-based in science, is more than proven in finance.

    Moreover, I have yet to encounter significant reports of morbidity or mortality, unlike orthodox medicine, which has a notable, iatrogenically-induced hazard rate. Research has shown that over 100,000 deaths are produced in the USA…annually!! This often provides income opportunities for the survivors, like it or not (the upside of our legal system).

    Did you know that we give 70% of antibiotics to healthy animals, so that they can live closer together and thus provide us with a huge supply of cheap food? I wonder what Professor Ernst would say about that! I’m quite sad that homeopathy gets assailed, while farmers are left in peace.
    There’s always a dark side to successful nations.

    We do not have a traveling circus like The Royal Family, for which each British citizen only pays 75 pence per year!! We pay a lot more for some rather un-entertaining puppets but this is sometimes justified by the knowledge that we are the world’s chosen enforcer. The magnificence of the military is a rare sight to behold.

    Homeopathy will serve you well, along with your ascetic bent. Dr. Kaplan is darn good, by the way. He can also cure psychological ailments with Provocative Therapy. He once treated me for a problem,…giving too much correct advice about making money. Sounds bizarre, eh? Wait till the ingrates don’t say THANK YOU!! In fact, he was so successful that when he asks me for such advice, I refuse. I will need to return to have some of the treatment reversed, and have him pay ME!!.

    When all is said and done Sastry, I sometimes do remember one thing: Health (body, mind, spirit) IS wealth! I challenge anybody to argue that.

    Regards,
    Fritz Kabongo MD.

  7. Sastry.M October 30, 2010 at 7:20 pm

    @Dr.Fritz Kabango,
    Many thanks for your kind acknowledgment and graphic narration of corporate hospital business staking human health for making money. The same picture is painting all over India presently with health insurance companies mushrooming in all major cities guaranteeing health under their shade.
    As aptly observed Homeopathic philosophy and therapeutics was developed by the ardent orthodox physician Dr.Samuel Hahnemann to combat morbidity of classical medicine and mortality due to toxic poisoning.Indeed EBM appeals to only gross physical nature with information extracted from external sensory organs and augmented with precision instruments but takes subtle mind processes for granted in arriving at conclusions. For example REM recordings of EEG in both active wakeful state and dream sleep state when external channels are greatly attenuated into physical unawareness- are observed to be the same. This surmises the fact that the subtle dream state personality undergoes the same emotional experiences as does the wakeful one and hence both states are similar as far as sensory experiences are concerned. The path is from subtle to gross as psycho-somatic to definite physical expression such as symptoms of a disease in a patient as his own expression or the art of carving a stone when in health if happens to be sculptor. The reverse in physical definitiveness as common evidence need not elicit the same subtle response of appeal such as to a visiting musician to his sculptor friend’s work. Homeopathy addresses subtle nature as well as gross effects and seeks to establish the commonality in a given individual to decide his/her constitution. Once recognized even a highly attenuated physical medicine of proven similarity can address the inner personality and produce physical response in the direction to health from disease even healing physical pathology as in the REM example.
    Coming to the wise conclusion that Health integrated to body, mind and spirit IS Wealth we acknowledge that Money is only a value attached promise by the 2/3 majority of mind and spirit created for the 1/3 minority comforts of physical body and becomes irrelevant when majority support is withdrawn.
    with sincere regards,
    Sastry.M

    • Dr. Kaplan October 30, 2010 at 7:23 pm

      Dr Sastry, I appoint you as my website’s official philosopher and guru.

  8. Sastry.M October 31, 2010 at 8:44 am

    Dr.Kaplan,
    Thanks sir for the appointment in appreciation of my freedom of expression but spare me with your kind excuse all blunders I may commit with a sense of overzealousness and scare of officialdom!
    with warm regards for your kindness,
    sicerely,
    Sastry.M

  9. Dr Amit Habbu November 1, 2010 at 9:32 pm

    @ Sastry M
    Its true that Hahnemann was very critical of orthodox medicine, but one must remember that he was critical of the orthodox medicine of his time. Modern medicine has come a long way and we need to give it its due. It saves lives without question, and i can confidently say far more lives in the emergency setting than homeopathic remedies. Homeopathy should be looked upon as a sub speciality of modern medicine and not an antagonistic therapeutic system.

    On this website and many others i find homeopathic doctors defending homeopathy against the malafide attacks by conventional doctors and others and this we must continue to do.

    However lets not make it into an “allopathy” versus homeopathy debate because both these systems of therapy have their own spheres of influence and relative efficacies for various illnesses.

  10. Sastry.M November 2, 2010 at 5:08 pm

    @Dr.Amit
    Absolutely true.There is no contest against efficacy or authority of standard orthodox medicine.It has progressed a long way along with Dr.Hahnemann’s new homeopathic system doing away with many practices he abhorred while as a practitioner himself.Credited with fund of medical knowledge acquired over the years and coupled with support of most modern precision electronic insrumentation covering all fields of diagnostics as well as therapeutic aids the orthodox medicine not only recognized and incorporated what Dr.Hahnemann yearned for in his days regarding cleanliness esp.of maternity wards but use medication with reduced dosage against grains and grams of his day also.The most note worthy is recognition of Psycho-Somatic order of disease progress and isopathic inoculation of refined disease cultures introducing somatic ‘reaction’and subsequent ‘psychic’ registration in brain to combat similar disease attacks in latter life.Although effective in majority and adverse in odd cases those noxious reactions can be rectified by supplementing homeo medicines.
    Thus progressed human medicine during 19’th and more than half during the last with a complementing opposition between the old and new systems but to the mutual benefit of common people of all economic classes and ironically the better informed upper preferring the latter.
    Progressing to the late 20’s and entering the 21’st time has seen the culmination of human ingeniousness in electronic micro miniaturization and incorporating artificial human intelligence in the development of computers augmenting all fields of research and development of the orthodox medicine and also greatly helping the new system in repertorized selection of homeopathic medicines as a first approximation aiding diagnostic selection.
    Now where is all the healthy opposing complementary competition between the two systems of medicine has gone? Inspite of human ingeniousness of progress in scientific,technical or all other fields where rational understanding and logical receptivity should have been inculcated an apparent dogmatic disingenuity is displayed with a prejudiced proclivity which is what Dr.Brian Kaplan and all conscentious Homeopaths of his school are lamenting about and fighting against.

    • Dr. Kaplan November 2, 2010 at 9:40 pm

      @ Sastry. M Thank you for that comment. All your comments on my site are most welcome.

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