Are we losing the art of diagnosis?

Robert Centor wonders.

Of course we are! The deck is stacked against the “art” of medicine. The malpractice environment favors objective results, and the reimibursement system does not reward thinking. That means more tests. Anyone surprised by this?

Comments

DermDoc
There is another way to look at this. Take a hypothetical analogy: lets say I invented two diagnostic machines – one is inexpensive but low sensitivity and specificity the other is expensive but high sensitivity and specificity. Which would you choose to help your patient?
Isn’t that analagous to using clinical diagnostic tests or choosing to use expensive studies?
You could diagnose an acute MI from Hx and physicial, or use diagnostic testing. Which would you choose?
I am sure we all agree that we must have both clinical skills and good judgement for using tests, but I am not sure that we have lost the art of diagnosis just because we now use more technologies to assist us.
asilvaPT
I agree that a combination of diagnostic tests and a thorough patient history and examination are essential. I have seen (both professionally and personally) health care professionals dance around what they are trying to say in order to cover themselves. I think if malpractice wasn’t so much in the forefront, providers could talk openly with their patients and give a full range of possible diagnoses without the risk of being sued for what their honest medical opinion might be.
http://blog.wellnessprofessionals.com/
Michael Rack, MD
I don’t see the problem so much as too much testing, rather the problem is that patients are sent for a test rather than the physician himself doing/interpreting a test. In the old days, physicians would perform many of the tests themselves (LP’s, paracentesis, etc) and would interpret most of them (including labs, x-rays). Too often these days patients are sent for an MRI/CT and the ordering physician gets a typed report from the radiologist and never sees the original scan.
Anonymous
“I think if malpractice wasn’t so much in the forefront, providers could talk openly with their patients and give a full range of possible diagnoses without the risk of being sued for what their honest medical opinion might be.”
How much of that fear is real and how much is imaginary? You seem to refer to malpractice much in the same way as our government has used its “army of evildoers” to enact one unchecked extension of presidential authority after another. It makes me wonder if your administrations aren’t using malpractice hype the same way — to get you to accept the unacceptable and become their puppets.
Yes, there are terrorists, and yes, apparently there are unjustifiable malpractice suits. In both cases, is it enough to turn your entire world upside down and become less than what you want to be?

Are we losing the art of diagnosis?

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